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General NPI Number Information
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NPI Number | 1154538924
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Entity Type | Individual
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Provider Name | JON SMILEY
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 4201 SOUTH GRAND
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City | MONROE
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State | LA
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Zip | 71201-0000
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Country | US
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Telephone | 601-250-4815
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Fax | 601-250-6859
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Provider Business Mailing Address
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Address Line | 103 MOSSY OAK DR
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City | WEST MONROE
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State | LA
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Zip | 71292-4101
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Country | US
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Telephone | 601-250-4815
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Fax | 601-250-6859
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTAZ20288
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License Number State | LA
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