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General NPI Number Information
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NPI Number | 1659761393
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Entity Type | Individual
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Provider Name | SAMANTHA RAE SMITH
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 345 E SUPERIOR ST
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City | CHICAGO
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State | IL
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Zip | 60611-2654
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Country | US
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Telephone | 312-238-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 15723 BRASSIE CT APT 2S
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City | ORLAND PARK
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State | IL
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Zip | 60462-5801
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Country | US
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Telephone | 708-285-5224
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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 | 056.010840
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License Number State | IL
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