Provider Demographics
NPI:1326323882
Name:SMITH, KATHLEEN LESH (LMT, CNMT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LESH
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JEAN
Other - Last Name:LESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HC 75 BOX 1250
Mailing Address - Street 2:
Mailing Address - City:LOS OJOS
Mailing Address - State:NM
Mailing Address - Zip Code:87551-9732
Mailing Address - Country:US
Mailing Address - Phone:575-588-7558
Mailing Address - Fax:575-756-1652
Practice Address - Street 1:16306-B HWY. 84
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520
Practice Address - Country:US
Practice Address - Phone:505-629-3480
Practice Address - Fax:575-756-1652
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist