Provider Demographics
NPI:1396834404
Name:SMITH, EFFIE MAY (COTA/)
Entity Type:Individual
Prefix:
First Name:EFFIE
Middle Name:MAY
Last Name:SMITH
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 1:529 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2407
Mailing Address - Country:US
Mailing Address - Phone:620-285-3874
Mailing Address - Fax:
Practice Address - Street 1:1114 W. LLTH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-1939
Practice Address - Country:US
Practice Address - Phone:620-285-6914
Practice Address - Fax:620-285-6173
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00313224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant