Individual
MRS. EMILY JANE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, MOT
Contact information
Practice address
1 STATE RD STE 3, NEWAYGO, MI 49337-7982
(800) 968-1331
Mailing address
167 HIGHLANDER DR NE, ROCKFORD, MI 49341-8297
(513) 739-0399
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201010068
MI
225X00000X
Occupational Therapist
OT.007437
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2542118
INDEPENDENT PROVIDER
OH
01
—
266345
NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY
OH
01
—
5201010068
MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI
01
—
OT. 007437
OHIO OCCUPATIONAL THERAPY, PHYSICAL THERAPY, AND ATHLETIC TRAINERS BOARD
OH
Enumeration date
05/07/2007
Last updated
03/08/2018
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