Provider Demographics
NPI:1427334754
Name:SMITH, TWILA N (OTRL)
Entity type:Individual
Prefix:
First Name:TWILA
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058B ESSEX HOUSE SQUARE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-0000
Mailing Address - Country:US
Mailing Address - Phone:703-582-5115
Mailing Address - Fax:301-499-2467
Practice Address - Street 1:6058B ESSEX HOUSE SQ
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-4315
Practice Address - Country:US
Practice Address - Phone:703-582-5115
Practice Address - Fax:301-499-2467
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT100000079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist