Provider Demographics
NPI:1730129842
Name:SMITH, ALLEN ERMITA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALLEN
Middle Name:ERMITA
Last Name:SMITH
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 1:1335 ARIANA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1879
Mailing Address - Country:US
Mailing Address - Phone:863-413-0802
Mailing Address - Fax:863-413-0812
Practice Address - Street 1:1335 ARIANA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1879
Practice Address - Country:US
Practice Address - Phone:863-413-0802
Practice Address - Fax:863-413-0812
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225X00000XOtherOCCUPATIONAL THERAPIST