Provider Demographics
NPI:1205248911
Name:SMITH, CASEY O'MALLEY (MSOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:O'MALLEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:CASEY
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1913 ALFRESCO PL # 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1809
Mailing Address - Country:US
Mailing Address - Phone:502-836-7246
Mailing Address - Fax:
Practice Address - Street 1:1913 ALFRESCO PL # 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1809
Practice Address - Country:US
Practice Address - Phone:502-836-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5998225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist