Individual
MS. MARY JOSEPHINE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2400 COLLEGE AVE, GOSHEN, IN 46528-5010
(574) 533-0351
Mailing address
1711 STEVENS AVE, ELKHART, IN 46516-4002
(574) 333-1120
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001082A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32001082A
STATE LICENSE
IN
Enumeration date
06/06/2008
Last updated
06/06/2008
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