Provider Demographics
NPI:1902460389
Name:SMIDOWICZ, KAROLINA J (OTR/L, CLT)
Entity Type:Individual
Prefix:MS
First Name:KAROLINA
Middle Name:J
Last Name:SMIDOWICZ
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:KAROLINA
Other - Middle Name:JULIA
Other - Last Name:SMIDOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1903 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3916
Practice Address - Country:US
Practice Address - Phone:336-718-6700
Practice Address - Fax:336-718-6798
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7798225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7798OtherNC BOARD OF OCCUPATIONAL THERAPY