Provider Demographics
NPI:1790985059
Name:SMITH, GEAN KAY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:GEAN
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 BEAVERCREST DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1710
Mailing Address - Country:US
Mailing Address - Phone:440-282-9171
Mailing Address - Fax:440-282-7723
Practice Address - Street 1:3650 BEAVERCREST DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1710
Practice Address - Country:US
Practice Address - Phone:440-282-9171
Practice Address - Fax:440-282-9171
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA3077224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant