Provider Demographics
NPI:1255491650
Name:SMITH, ANTHONY LYNN (OTRL)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:OTRL
Mailing Address - Street 1:107 MAMIE ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-7225
Mailing Address - Country:US
Mailing Address - Phone:334-493-4555
Mailing Address - Fax:
Practice Address - Street 1:2866 DAUPHIN ST
Practice Address - Street 2:SUITE W
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-2486
Practice Address - Country:US
Practice Address - Phone:251-476-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1174225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist