Provider Demographics
NPI:1467576165
Name:SMITH, AMI M (OTR)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:1 MEADOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:VA
Mailing Address - Zip Code:22974-3239
Mailing Address - Country:US
Mailing Address - Phone:434-589-3182
Mailing Address - Fax:
Practice Address - Street 1:1 MEADOW RIDGE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:VA
Practice Address - Zip Code:22974-3239
Practice Address - Country:US
Practice Address - Phone:434-589-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist