Provider Demographics
NPI:1376959361
Name:SMOOT, KRISTINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:SMOOT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44075 CANDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-1903
Mailing Address - Country:US
Mailing Address - Phone:734-788-5581
Mailing Address - Fax:
Practice Address - Street 1:44075 CANDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-1903
Practice Address - Country:US
Practice Address - Phone:734-788-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008840225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology