Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1007012 | OR |
NPI | 1356609713 |
---|---|
Provider Name | Mrs. Carlene Mercia Smith |
First Address | Eugene, OR 97401-1551 |
Second Address | Eugene, OR 97405-1861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 24/04/2012 |