Active NPI
Shannon Smith
- Occupational Therapy Assistant
- Monticello, MS
National Provider Identifier
1275860926
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- TA2242
- Practice address
- 1065 E Broad St
Monticello, MS 39654-7703 - Phone
- (601) 587-1211
- NPI assigned
- Nov 17, 2009
- Last updated
- Nov 17, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | TA2242 | MS | Primary |
Addresses
Primary practice location
1065 E Broad St
Monticello, MS 39654-7703
Mailing address
125 T W Bass Rd
Carson, MS 39427-6276
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA2242 | MS | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258416000000",
"number": "1275860926",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 T W BASS RD",
"city": "CARSON",
"state": "MS",
"postal_code": "394276276"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1065 E BROAD ST",
"city": "MONTICELLO",
"state": "MS",
"postal_code": "396547703",
"telephone_number": "601-587-1211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "SHANNON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-17",
"last_updated": "2009-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "MS",
"license": "TA2242",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, MS
- Sacred Hearts Home Care LLC
- Molly Grace Ready Sasser, NP-C
- Sherry Chance Pippen, DMD, PA (Oak Lane Family Dental)
- Amanda Rose Smith, FNP-C
- Austin Smith, OT
- South Mississippi Medical Supply and Veterans Serivces, LLC (South MS Medical Supply)
- Southwest Mississippi Planning and Development District
- Southwest Mississippi Regional Medical Center (Southwest Urology Clinic-Monticello)
- Southwest Mississippi Regional Medical Center (Lawrence County Family Practice)
- Southwest Mississippi Regional Medical Center (Lawrence County Primary Care)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.