Provider Demographics
NPI:1295819241
Name:SMITH, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-5245
Mailing Address - Country:US
Mailing Address - Phone:415-847-2098
Mailing Address - Fax:415-893-9931
Practice Address - Street 1:46 TRINITY DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-5245
Practice Address - Country:US
Practice Address - Phone:415-847-2098
Practice Address - Fax:415-893-9931
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA983124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23106ZOtherMEDICARE PIN NUMBER
CAZZZ23106ZOtherMEDICARE PIN NUMBER