Provider Demographics
NPI:1629511878
Name:SMITH, MADELINE LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:LEIGH
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 W. WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-636-3910
Mailing Address - Fax:479-202-9100
Practice Address - Street 1:2100 W. PERRY RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-631-3515
Practice Address - Fax:479-202-9105
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist