Provider Demographics
NPI:1023481728
Name:SMITH, PATRICK J (OTR/L)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 OLD OAK DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1121
Mailing Address - Country:US
Mailing Address - Phone:330-637-1312
Mailing Address - Fax:
Practice Address - Street 1:253 OLD OAK DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1121
Practice Address - Country:US
Practice Address - Phone:330-637-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT2304225X00000X
PAOC006124L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist