Provider Demographics
NPI:1891921011
Name:SMITH, JUDITH A (OT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MAIN STREET
Mailing Address - Street 2:SUITE #G5
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890
Mailing Address - Country:US
Mailing Address - Phone:781-729-8833
Mailing Address - Fax:781-729-8367
Practice Address - Street 1:955 MAIN STREET
Practice Address - Street 2:SUITE #G5
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-729-8833
Practice Address - Fax:781-729-8367
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4788150001Medicare NSC