Healthcare Provider Details

I. General information

NPI: 1922026772
Provider Name (Legal Business Name): JENNIFER SMITH OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST SUITE 200
PROVIDENCE RI
02905-3236
US

IV. Provider business mailing address

2 DARTMOUTH AVE
WARWICK RI
02888-4416
US

V. Phone/Fax

Practice location:
  • Phone: 401-457-1580
  • Fax: 401-831-0500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT00184
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: