Provider Demographics
NPI:1962450502
Name:SMITH, DEBORAH (OT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
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 1:9 MAPLE TREE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4070
Mailing Address - Country:US
Mailing Address - Phone:864-286-8288
Mailing Address - Fax:864-286-8289
Practice Address - Street 1:9 MAPLE TREE CT
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4070
Practice Address - Country:US
Practice Address - Phone:864-286-8288
Practice Address - Fax:864-286-8289
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6736Medicare ID - Type Unspecified
SCQ33237Medicare UPIN