Healthcare Provider Details

I. General information

NPI: 1447196308
Provider Name (Legal Business Name): NOEL LEA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 12TH ST N
MOUNTAIN LAKE MN
56159-1593
US

IV. Provider business mailing address

516 8TH ST N
MOUNTAIN LAKE MN
56159-1513
US

V. Phone/Fax

Practice location:
  • Phone: 951-321-9840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number106372
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: