Provider Demographics
NPI:1346451283
Name:SMITH, KIERSTEN A (MOTRL)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21018 NE 212TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9617
Mailing Address - Country:US
Mailing Address - Phone:360-687-2333
Mailing Address - Fax:
Practice Address - Street 1:FORT VANCOUVER CONVALESCENT CENTER
Practice Address - Street 2:8507 NE 8TH WAY
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-254-5335
Practice Address - Fax:360-892-2086
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003454225X00000X
OR1056214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist