Provider Demographics
NPI:1619523172
Name:SMITH, CAROL (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 KIRKWOOD PL N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5929
Mailing Address - Country:US
Mailing Address - Phone:425-301-9264
Mailing Address - Fax:
Practice Address - Street 1:4700 PHINNEY AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6399
Practice Address - Country:US
Practice Address - Phone:206-632-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001514225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist