Provider Demographics
NPI:1639296791
Name:SMITH, ABBY LOU (OTA)
Entity Type:Individual
Prefix:MISS
First Name:ABBY
Middle Name:LOU
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 248E
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-9776
Mailing Address - Country:US
Mailing Address - Phone:570-286-5180
Mailing Address - Fax:
Practice Address - Street 1:743 MAHONING ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-2232
Practice Address - Country:US
Practice Address - Phone:570-742-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP001300L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant