Individual
MRS. TRISTA LAVONNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
835 E POPLAR AVE, HWY 64 BYPASS, SELMER, TN 38375-1832
(731) 645-3201
(731) 645-4912
Mailing address
196 COUNTY ROAD 213, CORINTH, MS 38834-6897
(662) 284-4693
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0000003028
TN
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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