Provider Demographics
NPI:1407473259
Name:SMOKY MOUNTAIN OCCUPATIONAL THERAPY LLC
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN OCCUPATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD OTRL
Authorized Official - Phone:865-201-0213
Mailing Address - Street 1:2896 MCMAHAN SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-7623
Mailing Address - Country:US
Mailing Address - Phone:865-201-0213
Mailing Address - Fax:865-500-3730
Practice Address - Street 1:200 E BROADWAY AVE STE 150
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5761
Practice Address - Country:US
Practice Address - Phone:865-201-0213
Practice Address - Fax:865-500-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty