Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 133747 | KY |
N | 225XM0800X | Mental Health | 133747 | KY |
NPI | 1629279542 |
---|---|
Provider Name | Mrs. Judith Paige Smith |
First Address | Ashland, KY 41105-0790 |
Second Address | Ashland, KY 41102-5422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 31/10/2019 |