MEDICARE: MS. JESSICA MARIE SMITH OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5201007923	MI

General Provider Information

NPI Number	:	1043573306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA MARIE SMITH OTRL

Provider Business Mailing Address
First Line	:	5060 JACKSON RD STE D
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-1867
Country	:	US
Telephone Number	:	734-627-8001
Fax Number	:	734-433-1989

Provider Business Practice Location Address
First Line	:	5060 JACKSON RD STE D
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-1867
Country	:	US
Telephone Number	:	734-627-8001
Fax Number	:	734-433-1989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	02/29/2024

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