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General NPI Number Information
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NPI Number | 1750991071
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Entity Type | Individual
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Provider Name | JADE SMITH OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/01/2020
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 1244 E BETHANY HOME RD APT 33A
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City | PHOENIX
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State | AZ
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Zip | 85014-2043
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Country | US
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Telephone | 505-290-3917
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Fax |
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Provider Business Mailing Address
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Address Line | 1244 E BETHANY HOME RD APT 33A
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City | PHOENIX
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State | AZ
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Zip | 85014-2043
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Country | US
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Telephone | 505-290-3917
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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 | OTH-008482
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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