Provider Demographics
NPI:1649834722
Name:SMITH, ELIZABETH BLAIR (MOTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BLAIR
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12539 NATUREVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2984
Mailing Address - Country:US
Mailing Address - Phone:941-320-5377
Mailing Address - Fax:
Practice Address - Street 1:12539 NATUREVIEW CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-2984
Practice Address - Country:US
Practice Address - Phone:941-320-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist