Provider Demographics
NPI:1366631103
Name:KUCHARSKI SMITH, AMANDA R (LMT, CNMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:R
Last Name:KUCHARSKI SMITH
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 MAIN AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5083
Mailing Address - Country:US
Mailing Address - Phone:970-946-1323
Mailing Address - Fax:970-382-9828
Practice Address - Street 1:1911 MAIN AVE STE 260
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5083
Practice Address - Country:US
Practice Address - Phone:970-946-1323
Practice Address - Fax:970-382-9828
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.009660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist