Provider Demographics
NPI:1083848071
Name:SMITH, AMY BLATT (OT/L, CEAS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BLATT
Last Name:SMITH
Suffix:
Gender:F
Credentials:OT/L, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 FOREST BROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1623
Mailing Address - Country:US
Mailing Address - Phone:330-714-5224
Mailing Address - Fax:
Practice Address - Street 1:275 FOREST BROOK BLVD
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1623
Practice Address - Country:US
Practice Address - Phone:330-714-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT001794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist