Provider Demographics
NPI:1467188862
Name:SMALLMAN, SHAY LYNN (OTR/LOH)
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:LYNN
Last Name:SMALLMAN
Suffix:
Gender:F
Credentials:OTR/LOH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6513 US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:OH
Mailing Address - Zip Code:43540-9739
Mailing Address - Country:US
Mailing Address - Phone:419-388-8725
Mailing Address - Fax:
Practice Address - Street 1:555 ANTHONY WAYNE TRL
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1516
Practice Address - Country:US
Practice Address - Phone:419-878-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011159225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist