Provider Demographics
NPI:1326869561
Name:SMITH, JAMIE K (COTA/L)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:K
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ROSALES
Mailing Address - Street 1:3500 SUNRISE HWY STE 111
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-1001
Mailing Address - Country:US
Mailing Address - Phone:631-650-6545
Mailing Address - Fax:
Practice Address - Street 1:3500 SUNRISE HWY STE 111
Practice Address - Street 2:
Practice Address - City:GREAT RIVER
Practice Address - State:NY
Practice Address - Zip Code:11739-1001
Practice Address - Country:US
Practice Address - Phone:631-650-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant