Provider Demographics
NPI:1558313445
Name:NESMITH, KATHY EILEEN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:EILEEN
Last Name:NESMITH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 N LAWNWOOD CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-6958
Mailing Address - Country:US
Mailing Address - Phone:772-341-1289
Mailing Address - Fax:772-464-3365
Practice Address - Street 1:2100 NEBRASKA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4704
Practice Address - Country:US
Practice Address - Phone:772-465-8411
Practice Address - Fax:772-464-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 10772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer