Provider Demographics
NPI:1386786465
Name:SMYLE, JEROME W (OTR)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:W
Last Name:SMYLE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 YELLOWSTONE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1834
Mailing Address - Country:US
Mailing Address - Phone:406-245-9330
Mailing Address - Fax:406-254-9675
Practice Address - Street 1:1415 YELLOWSTONE RIVER RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1834
Practice Address - Country:US
Practice Address - Phone:406-245-9330
Practice Address - Fax:406-254-9675
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist