Provider Demographics
NPI:1477655496
Name:SMITH, DANIEL CARLTON (MS, OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CARLTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13537 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5899
Mailing Address - Country:US
Mailing Address - Phone:314-821-9126
Mailing Address - Fax:314-821-9142
Practice Address - Street 1:201 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63101-2304
Practice Address - Country:US
Practice Address - Phone:314-678-1008
Practice Address - Fax:314-678-1007
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000173970225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220081511Medicare PIN
MO220081509Medicare PIN