Provider Demographics
NPI:1982705943
Name:SMILEY, SUSAN ANNETTE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANNETTE
Last Name:SMILEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1917 WINGATE WAY
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3132
Mailing Address - Country:US
Mailing Address - Phone:510-582-6760
Mailing Address - Fax:510-845-4511
Practice Address - Street 1:15400 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1009
Practice Address - Country:US
Practice Address - Phone:510-895-4519
Practice Address - Fax:510-895-4511
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation