Provider Demographics
NPI:1063056356
Name:SMYTH, LAUREN ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:SMYTH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 ROCK FOREST DR APT 403
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7927
Mailing Address - Country:US
Mailing Address - Phone:267-229-7367
Mailing Address - Fax:
Practice Address - Street 1:9701 VEIRS DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3414
Practice Address - Country:US
Practice Address - Phone:301-424-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02793224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant