Provider Demographics
NPI:1053187609
Name:SMITH, CASSIDY CHILDS (OTD, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CASSIDY
Middle Name:CHILDS
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 JACK MCVEIGH DR
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-4688
Mailing Address - Country:US
Mailing Address - Phone:706-988-6612
Mailing Address - Fax:
Practice Address - Street 1:18 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-1846
Practice Address - Country:US
Practice Address - Phone:706-988-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008987225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist