Provider Demographics
NPI:1023504867
Name:SMITH, MADELINE (OTL)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2686 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3522
Mailing Address - Country:US
Mailing Address - Phone:650-368-3345
Mailing Address - Fax:510-879-0354
Practice Address - Street 1:2686 SPRING ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3522
Practice Address - Country:US
Practice Address - Phone:650-368-3345
Practice Address - Fax:510-879-0354
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19941225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist