Provider Demographics
NPI:1124696034
Name:SMITH-REED, JENNIFER D X (COTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:SMITH-REED
Suffix:X
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 RUGBY LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5982
Mailing Address - Country:US
Mailing Address - Phone:469-288-1808
Mailing Address - Fax:
Practice Address - Street 1:5521 VILLAGE CREEK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4829
Practice Address - Country:US
Practice Address - Phone:469-288-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208203224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant