Jerry Smith

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

5356-27 Issued in WI

Practice address

2125 N Sherri Lin CT Apt G
Appleton, WI 54914-1873

Phone

(920) 915-6832

NPI assigned

May 2, 2017

Sex

Male

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

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

{
    "created_epoch": "1493683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493683200000",
    "number": "1578099131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 N SHERRI LIN CT APT G",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 N SHERRI LIN CT APT G",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141873",
            "telephone_number": "920-915-6832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JERRY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-02",
        "last_updated": "2017-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WI",
            "license": "5356-27",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2407309421",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda R Smith, APNP
• Angela L Smith
• Christopher D Smith, OD
• Dean Smith, MD
• Heather Jean-Wittman Smith, COTA
• Jodie Ann Smith
• Jordan Smith, LMT
• Josette M Smith, LPC
• Marcia Ann Smith, ANP
• Michelle Smith

• Occupational Therapy Assistant in Appleton, WI
• Providers in Appleton, WI by specialty
• Occupational Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; 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.