MEDICARE: MISS ROSA MARIE SMITH BS OTR

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	31004261A	IN
2	225X00000X	Occupational Therapist	119814	TX

General Provider Information

NPI Number	:	1336368703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ROSA MARIE SMITH BS OTR

Provider Business Mailing Address
First Line	:	1205 BEACONSFIELD LN APT 301
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5048
Country	:	US
Telephone Number	:	817-818-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 12TH AVE STE 146
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3929
Country	:	US
Telephone Number	:	817-377-4011
Fax Number	:	817-377-9269

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	12/09/2024

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Directions to “ MISS ROSA MARIE SMITH BS OTR” Practice Location

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