MEDICARE: ANA L SMITH OTD, OTR/L

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	0915	NV

General Provider Information

NPI Number	:	1477748671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA L SMITH OTD, OTR/L

Provider Business Mailing Address
First Line	:	8925 TOMNITZ AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-7230
Country	:	US
Telephone Number	:	217-620-1871
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 MCLEOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4305
Country	:	US
Telephone Number	:	702-433-2200
Fax Number	:

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

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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