Provider Demographics
NPI:1205028024
Name:SMITH, MARY C (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1015 UNITY RD
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-9443
Mailing Address - Country:US
Mailing Address - Phone:870-364-1243
Mailing Address - Fax:870-364-1483
Practice Address - Street 1:1015 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-1243
Practice Address - Fax:870-364-1483
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR388225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist