Traci Marie Smith, MS, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

935 Issued in ND

Practice address

3100 W Lakeway Rd Ste 1
Gillette, WY 82718-6373

Phone

(307) 622-1242

NPI assigned

Oct 1, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

• Revive Therapy

  • Occupational Therapist
  • Gillette, WY
  • NPI 1730711060
  Authorized official Same address or phone

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585526400000",
    "number": "1194912428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4719 FAIRFAX LOOP",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585035827",
            "telephone_number": "701-391-2384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 W LAKEWAY RD STE 1",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827186373",
            "telephone_number": "307-622-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "TRACI",
        "middle_name": "MARIE",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-01",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WY",
            "license": "1480",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ND",
            "license": "935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Sindelar, PSS
• Kristi Kay Sires-Cannon, FNP, MSN
• Jenna Ann Sloan, PHARMD
• Michael Lee Smith, L.P.C.
• Sarah Anne Smith, DNP
• Smiths Food & Drug Centers Inc (Smiths Pharmacy #180)
• Marie Sneed
• Andrea Olive Snyder
• Sol Domus Group, LLC
• Sol Domus, Inc.

• Occupational Therapist in Gillette, WY
• Providers in Gillette, WY by specialty
• Occupational Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2020; 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.