Healthcare Provider Details

I. General information

NPI: 1912786641
Provider Name (Legal Business Name): ELIZABETH SMIDDY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 OLD WEISGARBER RD
KNOXVILLE TN
37909-2682
US

IV. Provider business mailing address

1240 OLD WEISGARBER RD
KNOXVILLE TN
37909-2682
US

V. Phone/Fax

Practice location:
  • Phone: 865-621-4249
  • Fax: 865-381-1371
Mailing address:
  • Phone: 865-621-4249
  • Fax: 865-381-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number7725
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: