Healthcare Provider Details

I. General information

NPI: 1265791792
Provider Name (Legal Business Name): MATTIE F. SMITH-MINTON MSOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 SUNNYSLOPE RD
MAPLE HEIGHTS OH
44137-3121
US

IV. Provider business mailing address

5570 SUNNYSLOPE RD
MAPLE HEIGHTS OH
44137-3121
US

V. Phone/Fax

Practice location:
  • Phone: 216-385-7488
  • Fax:
Mailing address:
  • Phone: 216-385-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number01273
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: