Individual
JACQUELINE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
120 HOSPITAL RD, SUITE 100, PRINCE FREDERICK, MD 20678-4022
(410) 414-4846
(410) 414-4810
Mailing address
16580 WATERSIDE PL, HUGHESVILLE, MD 20637-2823
(301) 274-9508
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
04457
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
606MH211
MECICARE PROVIDER ID
MD
05
—
770428300
—
MD
Enumeration date
11/30/2006
Last updated
06/25/2008
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