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NPI Code Detail

MEDICARE: JESSICA SMITH MS, OT/L

MEDICARE: JESSICA SMITH MS, OT/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
1225XP0200XPediatric Occupational TherapistTO2555ME
2225X00000XOccupational Therapist3906SC

General Provider Information

NPI Number : 1710268891
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SMITH MS, OT/L
Provider Business Mailing Address
First Line : 85 MIDDLE RD
Second Line :
City : CUMBERLAND
State : ME
Zip : 04021-3707
Country : US
Telephone Number : 207-829-8007
Fax Number : 207-829-8008
Provider Business Practice Location Address
First Line : 800 N LAKE DR
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-2903
Country : US
Telephone Number : 877-407-3422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2011
Last Update Date : 12/27/2024

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