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General NPI Number Information
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NPI Number | 1528235876
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Entity Type | Individual
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Provider Name | DEBRA SMITH OTR
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Gender | Female
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 501 N LAKE ST
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City | PESHTIGO
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State | WI
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Zip | 54157-1013
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Country | US
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Telephone | 715-582-3906
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Fax | 715-582-3141
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Provider Business Mailing Address
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Address Line | 261 FRENCH ST
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City | PESHTIGO
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State | WI
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Zip | 54157-1217
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Country | US
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Telephone | 715-582-2200
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Fax | 715-582-2222
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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 | 1767-026
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License Number State | WI
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