Provider Demographics
NPI:1215461496
Name:SMITH, MADONNA (OTR/L)
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N MILLER RD
Mailing Address - Street 2:STE 150A
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3770
Mailing Address - Country:US
Mailing Address - Phone:330-867-2240
Mailing Address - Fax:330-630-3198
Practice Address - Street 1:150 N MILLER RD
Practice Address - Street 2:STE 150A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3770
Practice Address - Country:US
Practice Address - Phone:330-867-2240
Practice Address - Fax:330-630-3198
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009723225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist