Provider Demographics
NPI:1104040815
Name:SMITH, EDITH L (OTL)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:MS
Other - First Name:EDITH
Other - Middle Name:SMITH
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTL
Mailing Address - Street 1:642 E 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513
Mailing Address - Country:US
Mailing Address - Phone:252-746-2509
Mailing Address - Fax:
Practice Address - Street 1:642 E 2ND STREET
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513
Practice Address - Country:US
Practice Address - Phone:252-746-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1459225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist