Healthcare Provider Details

I. General information

NPI: 1518605328
Provider Name (Legal Business Name): EMILY BETH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 BUFFALO RD
LAWRENCEBURG TN
38464-4809
US

IV. Provider business mailing address

2380 BUFFALO RD
LAWRENCEBURG TN
38464-4809
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-9418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7265
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: