Provider Demographics
NPI:1174926216
Name:SMITH, MICHAEL S (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 PORTER ST NW APT 303
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3273
Mailing Address - Country:US
Mailing Address - Phone:202-422-2100
Mailing Address - Fax:
Practice Address - Street 1:3018 PORTER ST NW APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3273
Practice Address - Country:US
Practice Address - Phone:202-422-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000233225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics