Individual
EVAN QUINN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
349 SEYMOUR RD, FAIRMONT, WV 26554-7437
(304) 692-6375
Mailing address
349 SEYMOUR RD, FAIRMONT, WV 26554-7437
(304) 692-6375
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2050
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2050
OCCUPATIONAL THERAPY LICENSE
WV
Enumeration date
10/20/2022
Last updated
10/20/2022
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