MEDICARE: MRS. KATHRYN SK SMITH OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	OT.0001576	CO
2	225XP0200X	Pediatric Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT.0001576	OTHER	CO	STATE OF COLORADO, DORA

General Provider Information

NPI Number	:	1982041679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN SK SMITH OTR

Provider Business Mailing Address
First Line	:	2832 STONEHAVEN DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5683
Country	:	US
Telephone Number	:	970-488-0773
Fax Number	:

Provider Business Practice Location Address
First Line	:	2832 STONEHAVEN DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5683
Country	:	US
Telephone Number	:	970-488-0773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	02/18/2020

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