Provider Demographics
NPI:1659772978
Name:SMART, ANITA (OTR)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-0644
Mailing Address - Country:US
Mailing Address - Phone:850-832-4072
Mailing Address - Fax:850-522-9829
Practice Address - Street 1:2500 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4412
Practice Address - Country:US
Practice Address - Phone:850-522-7951
Practice Address - Fax:850-522-9829
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3927225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist