Provider Demographics
NPI:1932308988
Name:SMITHSON, KAREN RENEE (COTA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RENEE
Last Name:SMITHSON
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 1:540 S PARKER ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3593
Mailing Address - Country:US
Mailing Address - Phone:810-765-8110
Mailing Address - Fax:810-765-9811
Practice Address - Street 1:23575 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3108
Practice Address - Country:US
Practice Address - Phone:586-791-2470
Practice Address - Fax:586-792-7668
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006098224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant