Healthcare Provider Details

I. General information

NPI: 1710268891
Provider Name (Legal Business Name): JESSICA SMITH MS, OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA KENNEDY

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N LAKE DR
LEXINGTON SC
29072-2903
US

IV. Provider business mailing address

85 MIDDLE RD
CUMBERLAND ME
04021-3707
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax:
Mailing address:
  • Phone: 207-829-8007
  • Fax: 207-829-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3906
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberTO2555
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: