Provider Demographics
NPI:1356803654
Name:SMITH, KATE LEE (MS, OTR/L, CPAM)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, OTR/L, CPAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16817A YEOHO RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9561
Mailing Address - Country:US
Mailing Address - Phone:410-491-7010
Mailing Address - Fax:
Practice Address - Street 1:142 BENNETT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-1316
Practice Address - Country:US
Practice Address - Phone:410-887-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06729225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist