Healthcare Provider Details

I. General information

NPI: 1952758302
Provider Name (Legal Business Name): MICHELLE MARIE KEE-SMITH CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE MARIE KEE CRT

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 OKEECHOBEE RD
FORT PIERCE FL
34947-5407
US

IV. Provider business mailing address

7204 LAKELAND BLVD
FORT PIERCE FL
34951-3009
US

V. Phone/Fax

Practice location:
  • Phone: 772-462-6601
  • Fax:
Mailing address:
  • Phone: 772-579-0189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT10879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: