Provider Demographics
NPI:1700988557
Name:SMETHIE, CHRISTINA SW (OTRL CHT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:SW
Last Name:SMETHIE
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:S
Other - Last Name:WILEY SMETHIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL CHT
Mailing Address - Street 1:208 MOSES CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5675
Mailing Address - Country:US
Mailing Address - Phone:561-319-7361
Mailing Address - Fax:
Practice Address - Street 1:1690 US HIGHWAY 1 S STE A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6024
Practice Address - Country:US
Practice Address - Phone:904-810-2101
Practice Address - Fax:904-810-2106
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 731225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG424ZOtherMEDICARE PTAN
FLAG243OtherMEDICARE PTAN GROUP
FL880568700Medicaid