# NANCY MARIE SMYTH.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255502241
- **Authorized official:** NANCY MARIE SMYTH O.T.R., M.O.T. (OCCUPATIONAL THERAPIST; OWNER)
- **Authorized official phone:** (802) 279-2091

## Contact information

- **Practice address:** 105-4 MAD RIVER GREEN, WAITSFIELD, VT 05673
- **Practice address phone:** (802) 279-2091
- **Practice address fax:** (802) 496-6606
- **Mailing address:** PO BOX 760, WAITSFIELD, VT 05673-0760
- **Mailing address phone:** (802) 279-2091
- **Mailing address fax:** (802) 496-6606

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 0720000083 | VT | Yes |

## Other

- **Enumeration date:** 03/18/2008
- **Last updated:** 09/23/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1255502241 | SELF | VT |