Provider Demographics
NPI:1538656251
Name:SMITH, CARLA RAE (OT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 LOTTS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9046
Mailing Address - Country:US
Mailing Address - Phone:606-233-2812
Mailing Address - Fax:606-233-2812
Practice Address - Street 1:8000 LOTTS CREEK RD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9046
Practice Address - Country:US
Practice Address - Phone:606-233-2812
Practice Address - Fax:606-233-2812
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY134122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty