Provider Demographics
NPI:1275283418
Name:SMITH, KELLY SUE (RRT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8436 MOORISH RD
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-8748
Mailing Address - Country:US
Mailing Address - Phone:989-798-4902
Mailing Address - Fax:989-777-8106
Practice Address - Street 1:8436 MOORISH RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-8748
Practice Address - Country:US
Practice Address - Phone:989-798-4902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered