Active NPI
Blake Eric Smith, COTA
- Occupational Therapy Assistant
- Pittsfield, MA
National Provider Identifier
1639547904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 008716-1
- Practice address
- 169 Valentine Rd
Pittsfield, MA 01201-3042 - Phone
- (413) 445-2300
- NPI assigned
- Sep 3, 2015
- Sex
- Male
- 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 | 008716-1 | NY | Primary |
Addresses
Primary practice location
169 Valentine Rd
Pittsfield, MA 01201-3042
Mailing address
12 Bena St
Pittsfield, MA 01201-1011
Phone (413) 770-6383
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 277684274 | Other | MA | TRICARE |
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 |
|---|---|---|---|
| 008716-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441238400000",
"number": "1639547904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 BENA ST",
"city": "PITTSFIELD",
"state": "MA",
"postal_code": "012011011",
"telephone_number": "413-770-6383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "169 VALENTINE RD",
"city": "PITTSFIELD",
"state": "MA",
"postal_code": "012013042",
"telephone_number": "413-445-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "BLAKE",
"middle_name": "ERIC",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-03",
"last_updated": "2015-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NY",
"license": "008716-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "277684274",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pittsfield, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.