Provider Demographics
NPI:1609135920
Name:SMITH, MILLICENT BECKHAM (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:BECKHAM
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:MILLICENT
Other - Middle Name:BECKHAM
Other - Last Name:LYGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2267 FARRINGTON LOOP W
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-7557
Mailing Address - Country:US
Mailing Address - Phone:251-281-5019
Mailing Address - Fax:
Practice Address - Street 1:2267 FARRINGTON LOOP W
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-7557
Practice Address - Country:US
Practice Address - Phone:251-281-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist