Provider Demographics
NPI:1851411250
Name:SMITHVALDIVIA, HELEN LANANNE (COTA)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:LANANNE
Last Name:SMITHVALDIVIA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:LANANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:544 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3105
Mailing Address - Country:US
Mailing Address - Phone:610-586-4617
Mailing Address - Fax:
Practice Address - Street 1:2100 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1400
Practice Address - Country:US
Practice Address - Phone:215-685-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002180-L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant