Provider Demographics
NPI:1407262744
Name:SMITH, JAHANNA NICOLE
Entity Type:Individual
Prefix:MS
First Name:JAHANNA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 CARPENTER ST UNIT 304
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1400
Mailing Address - Country:US
Mailing Address - Phone:401-450-2515
Mailing Address - Fax:
Practice Address - Street 1:299 CARPENTER ST UNIT 304
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1400
Practice Address - Country:US
Practice Address - Phone:401-450-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01738225X00000X
MA12379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist