Provider Demographics
NPI:1710181821
Name:SMITH, AMY AUTEN (COTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:AUTEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:NC
Mailing Address - Zip Code:28168-9383
Mailing Address - Country:US
Mailing Address - Phone:704-276-2099
Mailing Address - Fax:
Practice Address - Street 1:396 COOPER RD
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:NC
Practice Address - Zip Code:28168-9383
Practice Address - Country:US
Practice Address - Phone:704-276-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1163224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant