Provider Demographics
NPI:1932461142
Name:SMITH, TONIANN (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TONIANN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4112
Mailing Address - Country:US
Mailing Address - Phone:516-330-1463
Mailing Address - Fax:
Practice Address - Street 1:101 NORFOLK ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-3301
Practice Address - Country:US
Practice Address - Phone:212-566-8855
Practice Address - Fax:212-677-4853
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017287225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics