Provider Demographics
NPI:1386226652
Name:DOTY, KODI SMITH
Entity Type:Individual
Prefix:
First Name:KODI
Middle Name:SMITH
Last Name:DOTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KODI
Other - Middle Name:
Other - Last Name:SMITH-DOTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6613 S CHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-1557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6613 S CHEYENNE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-1557
Practice Address - Country:US
Practice Address - Phone:253-370-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist