Provider Demographics
NPI:1538532767
Name:SMITH, JENNIFER SIMPSON
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SIMPSON
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 1:320 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1517
Mailing Address - Country:US
Mailing Address - Phone:540-962-6226
Mailing Address - Fax:409-627-4475
Practice Address - Street 1:320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1517
Practice Address - Country:US
Practice Address - Phone:409-626-2265
Practice Address - Fax:540-962-7447
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119007005OtherOCCUPATIONAL THERAPIST LICENSE
356540OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY