Provider Demographics
NPI:1700218823
Name:SMITH, KIA MICHELLE (MOTR/L, MPH)
Entity Type:Individual
Prefix:MS
First Name:KIA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOTR/L, MPH
Other - Prefix:MS
Other - First Name:KIA
Other - Middle Name:MICHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOTR/L, MPH
Mailing Address - Street 1:14601 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2641
Mailing Address - Country:US
Mailing Address - Phone:708-349-8300
Mailing Address - Fax:708-403-7608
Practice Address - Street 1:14601 JOHN HUMPHREY DRIVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-349-8300
Practice Address - Fax:708-403-7608
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.10007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist