Provider Demographics
NPI:1861840985
Name:SMITH, JEAN R (OTR)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:R
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 1:66 PRESTON ST APT 19
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03244-5342
Mailing Address - Country:US
Mailing Address - Phone:617-259-0003
Mailing Address - Fax:
Practice Address - Street 1:18 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-6164
Practice Address - Country:US
Practice Address - Phone:603-532-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11650225X00000X
NH2718225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist