Provider Demographics
NPI:1356609713
Name:SMITH, CARLENE MERCIA
Entity type:Individual
Prefix:MRS
First Name:CARLENE
Middle Name:MERCIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 DARLENE LN
Mailing Address - Street 2:#158
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1551
Mailing Address - Country:US
Mailing Address - Phone:541-513-2084
Mailing Address - Fax:
Practice Address - Street 1:2360 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1861
Practice Address - Country:US
Practice Address - Phone:541-687-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1007012225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation