Provider Demographics
NPI:1437585148
Name:SMITH, JULIE ELAINE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ELAINE
Other - Last Name:PRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:6153 MORO BAY HWY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-9553
Mailing Address - Country:US
Mailing Address - Phone:870-312-0742
Mailing Address - Fax:
Practice Address - Street 1:714 W GROVE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4416
Practice Address - Country:US
Practice Address - Phone:870-863-8194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist