Provider Demographics
NPI:1811101736
Name:SMITHY, PAMELA SUE (OTR)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUE
Last Name:SMITHY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 MCCOY WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2361
Mailing Address - Country:US
Mailing Address - Phone:502-485-1812
Mailing Address - Fax:502-485-0059
Practice Address - Street 1:8014 VINE CREST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4675
Practice Address - Country:US
Practice Address - Phone:502-552-9209
Practice Address - Fax:502-485-0059
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRO272225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics