MEDICARE: MRS. JULIE ANN SMITH

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	OT002616	GA

General Provider Information

NPI Number	:	1891948378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANN SMITH

Provider Business Mailing Address
First Line	:	1013 RIVERBURCH PKWY
Second Line	:	SUITE 4
City	:	DALTON
State	:	GA
Zip	:	30721-8887
Country	:	US
Telephone Number	:	706-278-4438
Fax Number	:	706-226-7869

Provider Business Practice Location Address
First Line	:	1013 RIVERBURCH PKWY
Second Line	:	SUITE 4
City	:	DALTON
State	:	GA
Zip	:	30721-8887
Country	:	US
Telephone Number	:	706-278-4438
Fax Number	:	706-226-7869

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	10/29/2008

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