Provider Demographics
NPI:1164739199
Name:SMARTT, TYRONE ANTHONY I (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:ANTHONY
Last Name:SMARTT
Suffix:I
Gender:M
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 1:12026 131ST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2922
Mailing Address - Country:US
Mailing Address - Phone:718-577-7941
Mailing Address - Fax:
Practice Address - Street 1:11538 134TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2214
Practice Address - Country:US
Practice Address - Phone:718-577-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014923225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist