Provider Demographics
NPI:1427176619
Name:SMITH, NONI (COTA)
Entity type:Individual
Prefix:MRS
First Name:NONI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 CARRIAGE LN
Mailing Address - Street 2:#52
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4435
Mailing Address - Country:US
Mailing Address - Phone:801-272-5008
Mailing Address - Fax:801-272-5009
Practice Address - Street 1:4578 HIGHLAND DR
Practice Address - Street 2:SUITE 190
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4243
Practice Address - Country:US
Practice Address - Phone:801-272-5008
Practice Address - Fax:801-272-5009
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT275972-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant