Provider Demographics
NPI:1821385212
Name:SMITH, KEVIN (OTR)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 KATALIN COURT
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2161
Mailing Address - Country:US
Mailing Address - Phone:989-671-0866
Mailing Address - Fax:989-671-0867
Practice Address - Street 1:3707 KATALIN COURT
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2161
Practice Address - Country:US
Practice Address - Phone:989-671-0866
Practice Address - Fax:989-671-0867
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist