Provider Demographics
NPI:1215220157
Name:SMITH, KATIE CONDOS (LMT, NCMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:CONDOS
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT, NCMT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:CONDOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:KEARSARGE
Mailing Address - State:NH
Mailing Address - Zip Code:03847-0201
Mailing Address - Country:US
Mailing Address - Phone:603-986-2897
Mailing Address - Fax:
Practice Address - Street 1:64 KEARSARGE RD
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860
Practice Address - Country:US
Practice Address - Phone:603-986-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3300M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist