Provider Demographics
NPI:1912018334
Name:SMOOT, MANDYLEIGH S (MOT,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MANDYLEIGH
Middle Name:S
Last Name:SMOOT
Suffix:
Gender:F
Credentials:MOT,OTR/L
Other - Prefix:MISS
Other - First Name:MANDY
Other - Middle Name:LEIGH
Other - Last Name:SHERRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT,OTR/L
Mailing Address - Street 1:1 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-1660
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103213225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1075860OtherN.B.C.O.T