Provider Demographics
NPI:1336356427
Name:SMITH, ELIZABETH ARCHIBALD (OTRL)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ARCHIBALD
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 ROUTE ONE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON SPRINGS
Mailing Address - State:ME
Mailing Address - Zip Code:04981
Mailing Address - Country:US
Mailing Address - Phone:207-567-3652
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-469-2023
Practice Address - Fax:207-469-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME00029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist