Provider Demographics
NPI:1861517971
Name:SMITH, PATRICIA LOUISE (OTR)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:SMITH
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 1:904 W BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-3226
Mailing Address - Country:US
Mailing Address - Phone:913-526-6584
Mailing Address - Fax:
Practice Address - Street 1:6929 MATTHEW PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3607
Practice Address - Country:US
Practice Address - Phone:703-813-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004047225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist