Provider Demographics
NPI:1730359670
Name:SMITHSON, JOANN LUCILLE (COTA)
Entity type:Individual
Prefix:MS
First Name:JOANN
Middle Name:LUCILLE
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:EAST PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63845-1540
Mailing Address - Country:US
Mailing Address - Phone:573-649-3136
Mailing Address - Fax:
Practice Address - Street 1:126 SHANNON ST
Practice Address - Street 2:
Practice Address - City:EAST PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63845-1540
Practice Address - Country:US
Practice Address - Phone:573-649-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140385224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant