Provider Demographics
NPI:1295795540
Name:SMITH, CHARLES D (BS OT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:BS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:866-800-9147
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:1035 N HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:615-217-0259
Practice Address - Fax:615-217-1290
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1527225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4170804OtherBCBS OF TENNESSEE
TN446631Medicare ID - Type UnspecifiedGROUP
TN3655017Medicare PIN