MEDICARE: ALLISA J SMITH

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	028227	NY

General Provider Information

NPI Number	:	1104788660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISA J SMITH

Provider Business Mailing Address
First Line	:	387 ADAM ST
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-1903
Country	:	US
Telephone Number	:	716-471-8962
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 7TH ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-2161
Country	:	US
Telephone Number	:	716-847-2500
Fax Number	:

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

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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