Healthcare Provider Details

I. General information

NPI: 1326323882
Provider Name (Legal Business Name): KATHLEEN LESH SMITH L.M.T., C.N.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN JEAN LESH

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16306-B HWY. 84
CHAMA NM
87520
US

IV. Provider business mailing address

HC 75 BOX 1250
LOS OJOS NM
87551-9732
US

V. Phone/Fax

Practice location:
  • Phone: 505-629-3480
  • Fax: 575-756-1652
Mailing address:
  • Phone: 575-588-7558
  • Fax: 575-756-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6156
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: