Provider Demographics
NPI:1861977035
Name:SMITH, SAMANTHA RAE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-3423
Mailing Address - Country:US
Mailing Address - Phone:479-268-2949
Mailing Address - Fax:
Practice Address - Street 1:1501 S WALDRON RD STE 107
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2568
Practice Address - Country:US
Practice Address - Phone:479-226-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist