Provider Demographics
NPI:1073646485
Name:SMEDILE, MARIE M (COTA)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:M
Last Name:SMEDILE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 KINGS CROFT
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1103
Mailing Address - Country:US
Mailing Address - Phone:856-414-1584
Mailing Address - Fax:
Practice Address - Street 1:5101 N PARK DR
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4643
Practice Address - Country:US
Practice Address - Phone:856-665-9111
Practice Address - Fax:856-317-3430
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09032800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant