Provider Demographics
NPI:1477061679
Name:PATEL, SMITA (OTR/L)
Entity type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21818 RAINBOW LAKE CT
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6296
Mailing Address - Country:US
Mailing Address - Phone:850-559-4419
Mailing Address - Fax:
Practice Address - Street 1:21818 RAINBOW LAKE CT
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6296
Practice Address - Country:US
Practice Address - Phone:850-559-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X, 225X00000X
FLOT18894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18894OtherDEPARTMENT OF HEALTH BOARD OF OCCUPATIONAL THERAPY