Provider Demographics
NPI:1467665570
Name:SMITH, EMILY JANE (OTR/L, MOT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 HIGHLANDER DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8297
Mailing Address - Country:US
Mailing Address - Phone:513-739-0399
Mailing Address - Fax:
Practice Address - Street 1:1 STATE RD STE 3
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-7982
Practice Address - Country:US
Practice Address - Phone:800-968-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.007437225X00000X
MI5201010068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2542118OtherINDEPENDENT PROVIDER
OH266345OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY
OHOT. 007437OtherOHIO OCCUPATIONAL THERAPY, PHYSICAL THERAPY, AND ATHLETIC TRAINERS BOARD
MI5201010068OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS