Provider Demographics
NPI:1801331475
Name:SMITH, MICHAEL TREA (COTA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TREA
Last Name:SMITH
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 ELLISTON PL
Mailing Address - Street 2:APT 533
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5259
Mailing Address - Country:US
Mailing Address - Phone:229-347-2391
Mailing Address - Fax:
Practice Address - Street 1:2312 ELLISTON PL
Practice Address - Street 2:APT 533
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5259
Practice Address - Country:US
Practice Address - Phone:229-347-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2805224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant