Basic Information
| Provider Information | |||||||||
| NPI: | 1346705357 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | KIARA MONAYE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 FM 2452 | ||||||||
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| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751100417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036415292 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3033 W GREEN OAKS BLVD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760162261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172226000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2019 | ||||||||
| LastUpdateDate: | 02/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224ZE0001X | 2144662 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Environmental Modification |
No ID Information.