Provider Demographics
NPI:1649771064
Name:SMITH, MARIKA EMANUEL (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:EMANUEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 COLUMBIA AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3505
Mailing Address - Country:US
Mailing Address - Phone:571-229-2408
Mailing Address - Fax:
Practice Address - Street 1:505 COLUMBIA AVE APT 2
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3505
Practice Address - Country:US
Practice Address - Phone:571-229-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019771225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics