Provider Demographics
NPI:1346355658
Name:SMITH, SEAN B (OT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-2264
Mailing Address - Country:US
Mailing Address - Phone:309-274-6314
Mailing Address - Fax:309-274-4100
Practice Address - Street 1:525 S SWEETBRIAR DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-2264
Practice Address - Country:US
Practice Address - Phone:309-274-6314
Practice Address - Fax:309-274-4100
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-007640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist