MEDICARE: ASHLEY ELIZABETH TANNER SMITHSON

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	3997	SC

General Provider Information

NPI Number	:	1588303135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ELIZABETH TANNER SMITHSON

Provider Business Mailing Address
First Line	:	611 26TH AVE S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-4449
Country	:	US
Telephone Number	:	843-455-7949
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 26TH AVE S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-4449
Country	:	US
Telephone Number	:	843-455-7949
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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