Provider Demographics
NPI:1801387410
Name:SMITH, EMILEE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 STATE ROUTE 314
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:OH
Mailing Address - Zip Code:43334-9729
Mailing Address - Country:US
Mailing Address - Phone:419-768-3301
Mailing Address - Fax:
Practice Address - Street 1:1300 STATE ROUTE 314
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:OH
Practice Address - Zip Code:43334-9729
Practice Address - Country:US
Practice Address - Phone:419-768-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10146225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist