Provider Demographics
NPI:1740530872
Name:SMITH-SALLEE, KRISTI (LMT, CMT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:SMITH-SALLEE
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4383 HIGHWAY 62 NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-6720
Mailing Address - Country:US
Mailing Address - Phone:502-777-7987
Mailing Address - Fax:
Practice Address - Street 1:4383 HIGHWAY 62 NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-6720
Practice Address - Country:US
Practice Address - Phone:502-777-7987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1714225700000X
INMT20903153225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist