Provider Demographics
NPI:1366924441
Name:GILL-SMITH, CHINYERE (OTR/L)
Entity type:Individual
Prefix:
First Name:CHINYERE
Middle Name:
Last Name:GILL-SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 GLENWATER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8557
Mailing Address - Country:US
Mailing Address - Phone:704-549-0807
Mailing Address - Fax:704-503-5481
Practice Address - Street 1:2390 127 MURRAH DRIVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-328-6518
Practice Address - Fax:803-327-4638
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1953225X00000X
NC1621225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist