Individual
MR. ZACK WESLEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTA
Contact information
Practice address
1005 MIDWESTERN PKWY, WICHITA FALLS, TX 76302-2211
(940) 322-0771
(940) 766-4943
Mailing address
12066 NE KEENEY RD, ELGIN, OK 73538-3761
(940) 322-0771
(940) 766-4943
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
403749
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111408402
—
TX
Enumeration date
10/09/2009
Last updated
10/09/2009
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