Individual
JOHANNA AILEEN SMITH BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
26900 CEDAR RD, BEACHWOOD, OH 44122-1191
(216) 839-3777
Mailing address
23351 CHAGRIN BLVD APT 404, BEACHWOOD, OH 44122-5522
(419) 345-0565
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
404778
NBCOT
—
01
—
OT-010251
OHIO OTPTATC BOARD
OH
Enumeration date
11/29/2022
Last updated
11/29/2022
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