Provider Demographics
NPI:1477798585
Name:SMITH, INGRID HOLT (OTR)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:HOLT
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 1:15 WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1042
Mailing Address - Country:US
Mailing Address - Phone:914-528-0007
Mailing Address - Fax:914-528-0007
Practice Address - Street 1:15 WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1042
Practice Address - Country:US
Practice Address - Phone:914-528-0007
Practice Address - Fax:914-528-0007
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006307-1225XP0200X
CT1218225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics