Provider Demographics
NPI:1750893475
Name:SMITH, PERRY DALE II (OTR/L)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:DALE
Last Name:SMITH
Suffix:II
Gender:M
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 1:14600 SAINT STEPHENS AVE
Mailing Address - Street 2:
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518-6711
Mailing Address - Country:US
Mailing Address - Phone:251-847-2223
Mailing Address - Fax:
Practice Address - Street 1:14600 SAINT STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518-6711
Practice Address - Country:US
Practice Address - Phone:251-847-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3417225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist