Provider Demographics
NPI:1831507433
Name:JEFFRIES-SMITH, KATHLEEN (COTA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JEFFRIES-SMITH
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 1:1816 BRIARWOOD INDUSTRIAL CT NE STE A
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1642
Mailing Address - Country:US
Mailing Address - Phone:253-906-1514
Mailing Address - Fax:
Practice Address - Street 1:1816 BRIARWOOD INDUSTRIAL CT NE STE A
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1642
Practice Address - Country:US
Practice Address - Phone:253-906-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001237174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist