Provider Demographics
NPI:1669883161
Name:SMITH, CYNTHIA E (OTR/L)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CAROLINA MDWS
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-8471
Mailing Address - Country:US
Mailing Address - Phone:919-904-7059
Mailing Address - Fax:
Practice Address - Street 1:500 CAROLINA MDWS
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8471
Practice Address - Country:US
Practice Address - Phone:919-904-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002276L225X00000X
NC9799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist