Provider Demographics
NPI:1912786641
Name:SMIDDY, ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SMIDDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2682
Mailing Address - Country:US
Mailing Address - Phone:865-621-4249
Mailing Address - Fax:865-381-1371
Practice Address - Street 1:1240 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2682
Practice Address - Country:US
Practice Address - Phone:865-621-4249
Practice Address - Fax:865-381-1371
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7725225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics