Provider Demographics
NPI:1275680324
Name:SMITH, DOUGLAS OLIVER (MOT, OTRL, ABDA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:OLIVER
Last Name:SMITH
Suffix:
Gender:M
Credentials:MOT, OTRL, ABDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 SANTA BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-1360
Mailing Address - Country:US
Mailing Address - Phone:863-385-4380
Mailing Address - Fax:863-385-4529
Practice Address - Street 1:1330 HIGHWAY 17 SOUTH
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873
Practice Address - Country:US
Practice Address - Phone:863-767-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XE1200X, 225XR0403X
FL0001768225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Not Answered225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility