Provider Demographics
NPI:1295278836
Name:SMITH, JANA BERISWILL (MOT)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:BERISWILL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:ELIZABETH
Other - Last Name:BERISWILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:315 N QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2614
Mailing Address - Country:US
Mailing Address - Phone:813-404-4848
Mailing Address - Fax:
Practice Address - Street 1:250 NW 76TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6668
Practice Address - Country:US
Practice Address - Phone:352-505-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17600225X00000X
FLOT17600225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist