Provider Demographics
NPI:1447420112
Name:SMITH, DOROTHY E (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 S 750 E
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47232-9719
Mailing Address - Country:US
Mailing Address - Phone:812-350-7171
Mailing Address - Fax:812-579-6404
Practice Address - Street 1:6100 S 750 E
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:IN
Practice Address - Zip Code:47232-9719
Practice Address - Country:US
Practice Address - Phone:812-350-7171
Practice Address - Fax:812-579-6404
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003234A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics