Provider Demographics
NPI:1215687033
Name:SMITH, MARGARET LISA ELIZABETH (OTR)
Entity type:Individual
Prefix:
First Name:MARGARET LISA
Middle Name:ELIZABETH
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 1:5185 TERRAZA QUINTANA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1548
Mailing Address - Country:US
Mailing Address - Phone:858-200-5760
Mailing Address - Fax:
Practice Address - Street 1:LANTERN CREST
Practice Address - Street 2:800 LANTERN CREST WAY
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:99207-1548
Practice Address - Country:US
Practice Address - Phone:858-200-5760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist