MEDICARE: SUSAN P. 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	OTR2107	AR

General Provider Information

NPI Number	:	1578766606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN P. SMITH OTRL

Provider Business Mailing Address
First Line	:	1020 SANDINO DR
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-8738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 SANDINO DR
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-8738
Country	:	US
Telephone Number	:	870-919-3141
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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