Provider Demographics
NPI:1457805186
Name:SMITH, BARTON BLAZER (COTA/L)
Entity Type:Individual
Prefix:
First Name:BARTON
Middle Name:BLAZER
Last Name:SMITH
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BUSBEE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-5104
Mailing Address - Country:US
Mailing Address - Phone:865-621-0381
Mailing Address - Fax:
Practice Address - Street 1:210 BUSBEE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-5104
Practice Address - Country:US
Practice Address - Phone:865-621-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1036314000000X
CAOTA 2139314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility