Provider Demographics
NPI:1962817007
Name:SMITH, CALLIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:B
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-0450
Mailing Address - Country:US
Mailing Address - Phone:931-722-2778
Mailing Address - Fax:931-722-7569
Practice Address - Street 1:514 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2615
Practice Address - Country:US
Practice Address - Phone:931-722-2778
Practice Address - Fax:931-722-7569
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2393224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant