Provider Demographics
NPI:1770532541
Name:SMITH, PRISCILLA ELISABETH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:ELISABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:ELISABETH
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:105 YAUPON DR
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550
Mailing Address - Country:US
Mailing Address - Phone:843-319-3125
Mailing Address - Fax:
Practice Address - Street 1:131 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-3037
Practice Address - Country:US
Practice Address - Phone:843-339-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3941225XP0200X
SC2231225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics