Nicole Sisson Smith, OTR

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

6791 Issued in TN

Practice address

514 S Brown St
Springfield, TN 37172-2937

Phone

(615) 988-4552

Fax

(615) 382-0501

NPI assigned

Feb 25, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shine Pediatric Therapy

  • Occupational Therapist
  • Springfield, TN
  • NPI 1891041133

  Multi-Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1154915411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1637",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371721637",
            "telephone_number": "615-988-4552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 S BROWN ST",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371722937",
            "telephone_number": "615-988-4552",
            "fax_number": "615-382-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISSON SMITH",
        "first_name": "NICOLE",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-25",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TN",
            "license": "6791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "6791",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Rae Shutt
• Helen Sile, M.D.
• McKenzie Simon
• Jennifer Singleton Ashworth, MD
• Denise Siroky Hill, MS CCC SLP
• Kimberley M Slaughter, FNP- BC
• Megan Slaughter
• Don R Sloan
• Drew Sloan, PHARM.D.
• Lillian Sloan

• Pediatric Occupational Therapist in Springfield, TN
• Providers in Springfield, TN by specialty
• Pediatric Occupational Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.