Provider Demographics
NPI:1164821674
Name:SMET, MARY (COTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SMET
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 1:1440 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2073
Mailing Address - Country:US
Mailing Address - Phone:920-682-0314
Mailing Address - Fax:920-683-0120
Practice Address - Street 1:1440 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2073
Practice Address - Country:US
Practice Address - Phone:920-682-0314
Practice Address - Fax:920-683-0120
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1155-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant