Individual
TABITHA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
377 WESTRIDGE BLVD, GREENWOOD, IN 46142
(317) 888-4948
Mailing address
722 KEYSTONE LN, VERNON HILLS, IL 60061-2351
(765) 412-9377
(866) 785-4924
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005092A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679863401
—
IN
Enumeration date
04/13/2011
Last updated
08/10/2018
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