Provider Demographics
NPI:1538358221
Name:SMYTH, JILL ALISON (OTR)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ALISON
Last Name:SMYTH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7906
Mailing Address - Country:US
Mailing Address - Phone:256-464-0521
Mailing Address - Fax:
Practice Address - Street 1:5275 MILLENNIUM DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2457
Practice Address - Country:US
Practice Address - Phone:256-489-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 2386225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist