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General NPI Number Information
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NPI Number | 1184238990
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Entity Type | Organization
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Legal Business Name | REBECKA L SMITH OT, LLC
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 5715 HIGHWAY 85 N
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City | CRESTVIEW
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State | FL
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Zip | 32536-9003
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Country | US
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Telephone | 850-331-3581
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Fax |
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Provider Business Mailing Address
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Address Line | 712 NAUGHTON DR
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City | CRESTVIEW
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State | FL
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Zip | 32536-9229
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | REBECKA SMITH
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Credential |
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Telephone | 850-543-8893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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