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General NPI Number Information
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NPI Number | 1194912428
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Entity Type | Individual
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Provider Name | TRACI MARIE SMITH MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 3100 W LAKEWAY RD STE 1
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City | GILLETTE
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State | WY
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Zip | 82718-6373
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Country | US
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Telephone | 307-622-1242
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Fax |
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Provider Business Mailing Address
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Address Line | 4719 FAIRFAX LOOP
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City | BISMARCK
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State | ND
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Zip | 58503-5827
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Country | US
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Telephone | 701-391-2384
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1480
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License Number State | WY
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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 | 935
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License Number State | ND
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