Provider Demographics
NPI:1477919355
Name:SMITH, CHELSEA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 FORTUNE HILL LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4140
Mailing Address - Country:US
Mailing Address - Phone:513-668-8668
Mailing Address - Fax:
Practice Address - Street 1:103 WINDSOR PATH
Practice Address - Street 2:SUITE 4
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9610
Practice Address - Country:US
Practice Address - Phone:502-863-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.008793225X00000X
KYR5738225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist