Provider Demographics
NPI:1144239575
Name:SMITH, KELLY D (OT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 NW SAINT MARY DR
Mailing Address - Street 2:STE 220
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2524
Mailing Address - Country:US
Mailing Address - Phone:816-220-3900
Mailing Address - Fax:816-220-0877
Practice Address - Street 1:801 NW SAINT MARY DR
Practice Address - Street 2:STE 220
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2524
Practice Address - Country:US
Practice Address - Phone:816-220-3900
Practice Address - Fax:816-220-0877
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005135225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26739012OtherBCBS KC
MO578907909Medicaid
MO578907909Medicaid