Provider Demographics
NPI:1326014192
Name:SMITH, KAREN (BS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:BRADIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10522 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14062-9607
Mailing Address - Country:US
Mailing Address - Phone:716-848-9510
Mailing Address - Fax:
Practice Address - Street 1:106 PINE ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5125
Practice Address - Country:US
Practice Address - Phone:716-646-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011725225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4430Medicare UPIN