Individual
MRS. JEANIE LOU SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
302 CEDER RIDGE RD., SISSONVILLE, WV 25320
(304) 984-0046
Mailing address
598 BERRY HILLS DR, CHARLESTON, WV 25309-6080
(681) 945-5078
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1879
WV
Other
Enumeration date
12/12/2012
Last updated
12/12/2012
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