Provider Demographics
NPI:1437858305
Name:SMITH, JALEIGH KITCHENS (OTR/L)
Entity Type:Individual
Prefix:
First Name:JALEIGH
Middle Name:KITCHENS
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 1:3887 BUSTER CIR
Mailing Address - Street 2:
Mailing Address - City:GIBSON
Mailing Address - State:GA
Mailing Address - Zip Code:30810-4625
Mailing Address - Country:US
Mailing Address - Phone:706-466-5429
Mailing Address - Fax:
Practice Address - Street 1:5176 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-2802
Practice Address - Country:US
Practice Address - Phone:706-842-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist