Provider Demographics
NPI:1295904357
Name:SMITH, JUDITH A (OT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:LEMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4106 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4169
Practice Address - Country:US
Practice Address - Phone:302-894-1600
Practice Address - Fax:302-894-1601
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10001044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295904357OtherCHAMPUS TRICARE
3506369000OtherIBC
DE1295904357Medicaid
3506369000OtherIBC
1295904357OtherCHAMPUS TRICARE