Basic Information
| Provider Information | |||||||||
| NPI: | 1366924441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILL-SMITH | ||||||||
| FirstName: | CHINYERE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9200 GLENWATER DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282628557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045490807 | ||||||||
| FaxNumber: | 7045035481 | ||||||||
| Practice Location | |||||||||
| Address1: | 2390 127 MURRAH DRIVE | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033286518 | ||||||||
| FaxNumber: | 8033274638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2018 | ||||||||
| LastUpdateDate: | 09/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1953 | SC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 1621 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.