Provider Demographics
NPI:1841534492
Name:SMITH, CAROLYN ANN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 KAULANA ST
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2050
Mailing Address - Country:US
Mailing Address - Phone:808-877-8740
Mailing Address - Fax:808-871-7487
Practice Address - Street 1:472 KAULANA ST
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2050
Practice Address - Country:US
Practice Address - Phone:808-877-8740
Practice Address - Fax:808-871-7487
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006665224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant