Provider Demographics
NPI:1760634711
Name:SMITH, SHAWNEE (OT,LMT)
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:OT,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 LAKE EMERALD DR
Mailing Address - Street 2:# 102
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6272
Mailing Address - Country:US
Mailing Address - Phone:646-413-9256
Mailing Address - Fax:
Practice Address - Street 1:118 LAKE EMERALD DR
Practice Address - Street 2:# 102
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-6272
Practice Address - Country:US
Practice Address - Phone:646-413-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49229225700000X
FL13379225X00000X
FLOT13379222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist