Provider Demographics
NPI:1528210457
Name:SMETHURST, KATHERINE L (LAC, MSTOM)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:SMETHURST
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 87TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2938
Mailing Address - Country:US
Mailing Address - Phone:212-769-1377
Mailing Address - Fax:
Practice Address - Street 1:160 W 87TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2938
Practice Address - Country:US
Practice Address - Phone:212-769-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist