Provider Demographics
NPI:1083339527
Name:SMITH, MADELINE CONRAD (COTA/L)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:CONRAD
Last Name:SMITH
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 1:182 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6140
Mailing Address - Country:US
Mailing Address - Phone:207-595-0985
Mailing Address - Fax:
Practice Address - Street 1:182 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6140
Practice Address - Country:US
Practice Address - Phone:603-447-6356
Practice Address - Fax:800-884-5007
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1120224Z00000X
ME0A4341224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty