Provider Demographics
NPI:1841786142
Name:SMITH, RENATE HILDEGARD (OTR)
Entity type:Individual
Prefix:MRS
First Name:RENATE
Middle Name:HILDEGARD
Last Name:SMITH
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 1:1245 MOREHEAD CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6180
Mailing Address - Country:US
Mailing Address - Phone:734-657-6982
Mailing Address - Fax:734-929-5894
Practice Address - Street 1:1200 EARHART RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2768
Practice Address - Country:US
Practice Address - Phone:734-929-6786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI484550225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist