Healthcare Provider Details

I. General information

NPI: 1457124190
Provider Name (Legal Business Name): DR. SHEILA R SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5317 S MONTE DR
OKLAHOMA CITY OK
73119-5447
US

IV. Provider business mailing address

PO BOX 818
CHOCTAW OK
73020-0818
US

V. Phone/Fax

Practice location:
  • Phone: 678-923-2186
  • Fax:
Mailing address:
  • Phone: 678-923-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: