MEDICARE: CAROL SMITH MOT, 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	OT00001514	WA

General Provider Information

NPI Number	:	1619523172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SMITH MOT, OTR/L

Provider Business Mailing Address
First Line	:	5635 KIRKWOOD PL N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5929
Country	:	US
Telephone Number	:	425-301-9264
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 PHINNEY AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-6399
Country	:	US
Telephone Number	:	206-632-7400
Fax Number	:

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

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	08/12/2019

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