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General NPI Number Information
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NPI Number | 1265634299
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Entity Type | Individual
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Provider Name | SUSAN GREGORY SMITH OTRL
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 WILLOW VALLEY LAKES DR
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City | WILLOW STREET
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State | PA
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Zip | 17584-9450
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Country | US
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Telephone | 717-464-6824
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Fax |
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Provider Business Mailing Address
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Address Line | 105 PLUMERIA PL
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City | LANCASTER
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State | PA
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Zip | 17602-6101
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Country | US
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Telephone | 717-464-3288
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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 | OC001200L
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License Number State | PA
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