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General NPI Number Information
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NPI Number | 1003429150
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Entity Type | Individual
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Provider Name | MACKENNA SMITH PTA, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 109 COMMERCE ST
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City | PARIS
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State | TN
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Zip | 38242-4917
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Country | US
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Telephone | 731-336-7352
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Fax |
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Provider Business Mailing Address
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Address Line | 178 LAYMAN RD
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City | TRENTON
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State | TN
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Zip | 38382-9762
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Country | US
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Telephone | 731-618-2114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 7475
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 8465
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License Number State | TN
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