Basic Information
| Provider Information | |||||||||
| NPI: | 1174193411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | OTR, CLT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 COPLEN RD | ||||||||
| Address2: | |||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420666428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032168177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1253 LAKE BARKLEY DR | ||||||||
| Address2: | |||||||||
| City: | KUTTAWA | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420556124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703882291 | ||||||||
| FaxNumber: | 2703880948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2021 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 265527 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.