Provider Demographics
NPI:1518275007
Name:SMITH, DEBORAH (COTA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1447
Mailing Address - Country:US
Mailing Address - Phone:785-562-6717
Mailing Address - Fax:
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PRETTY PRAIRIE
Practice Address - State:KS
Practice Address - Zip Code:67570-9202
Practice Address - Country:US
Practice Address - Phone:620-459-6822
Practice Address - Fax:620-459-7277
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-000312224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant