Provider Demographics
NPI:1407880313
Name:SMITH, JENNIFER CARTER (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CARTER
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MEDICAL DR
Mailing Address - Street 2:SUITES E & F
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7502
Mailing Address - Country:US
Mailing Address - Phone:252-757-1691
Mailing Address - Fax:252-757-3993
Practice Address - Street 1:640 MEDICAL DR
Practice Address - Street 2:SUITES E & F
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7502
Practice Address - Country:US
Practice Address - Phone:252-757-1691
Practice Address - Fax:252-757-3993
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist