Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 353025 | OR |
N | 225XH1200X | Occupational Therapist - Hand | 353025 | OR |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 353025 | OR |
NPI | 1023477700 |
---|---|
Provider Name | Mrs. Lora Bea Smith |
First Address | Wilsonville, OR 97070-5485 |
Second Address | Wilsonville, OR 97070-5485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2016 |
Last Update Date | 12/02/2019 |