Provider Demographics
NPI:1891249017
Name:SMEDLEYSKADSEN, MARLA (OT/L)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:SMEDLEYSKADSEN
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5815
Mailing Address - Country:US
Mailing Address - Phone:605-367-7900
Mailing Address - Fax:
Practice Address - Street 1:3101 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5809
Practice Address - Country:US
Practice Address - Phone:605-367-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0011225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics