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General NPI Number Information
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NPI Number | 1720754377
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Entity Type | Individual
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Provider Name | AMY JANELLE SMITH OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1401 LEO ST
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City | DAYTON
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State | OH
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Zip | 45404-1700
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Country | US
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Telephone | 937-542-6130
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 SPRINGFIELD ST
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City | DAYTON
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State | OH
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Zip | 45431-1084
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Country | US
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Telephone | 937-241-6111
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT-6390
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License Number State | OH
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