Provider Demographics
NPI:1144425265
Name:SMITH, SYMATHIA D (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SYMATHIA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1556 SOUTHBURY AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5252
Mailing Address - Country:US
Mailing Address - Phone:804-291-6128
Mailing Address - Fax:
Practice Address - Street 1:1741 E BELT BLVD
Practice Address - Street 2:ATTN: 4215TH USA HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-4913
Practice Address - Country:US
Practice Address - Phone:804-675-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003410225X00000X, 286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No286500000XHospitalsMilitary Hospital