Provider Demographics
NPI:1558703207
Name:SMITH, AMY MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:DANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:404 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67505-1813
Mailing Address - Country:US
Mailing Address - Phone:620-802-3471
Mailing Address - Fax:
Practice Address - Street 1:6700 E 45TH ST N
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-8817
Practice Address - Country:US
Practice Address - Phone:316-744-4109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00841224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant