Provider Demographics
NPI:1881140622
Name:SMITH, KRISTINE CAROL (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:CAROL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N. SPRING AVE
Mailing Address - Street 2:HAWTHORNE ELEMENTARY
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104
Mailing Address - Country:US
Mailing Address - Phone:605-321-4879
Mailing Address - Fax:
Practice Address - Street 1:601 N. SPRING AVE
Practice Address - Street 2:HAWTHORNE ELEMENTARY
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104
Practice Address - Country:US
Practice Address - Phone:605-321-4879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0502225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist