Provider Demographics
NPI:1982843413
Name:SMITH, ELIZABETH (OTR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ROPER MTN RD EXT
Mailing Address - Street 2:APT 715 G
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4825
Mailing Address - Country:US
Mailing Address - Phone:864-380-2481
Mailing Address - Fax:
Practice Address - Street 1:230 ROPER MTN RD EXT
Practice Address - Street 2:APT 715 G
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4825
Practice Address - Country:US
Practice Address - Phone:864-380-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3385225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist