Provider Demographics
NPI:1669625026
Name:SMITH, PADRA LYNN (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:PADRA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 WARREN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4469
Mailing Address - Country:US
Mailing Address - Phone:832-385-1430
Mailing Address - Fax:
Practice Address - Street 1:130 WILLIAM ST STE 641
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3806
Practice Address - Country:US
Practice Address - Phone:832-385-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012709-1225XP0200X
NJ46TR00436400225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics