Healthcare Provider Details

I. General information

NPI: 1700324936
Provider Name (Legal Business Name): KRISTEN SMITH AND ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 NW 144TH ST
EDMOND OK
73013-2411
US

IV. Provider business mailing address

309 NW 144TH ST
EDMOND OK
73013-2411
US

V. Phone/Fax

Practice location:
  • Phone: 405-388-8545
  • Fax: 888-606-5313
Mailing address:
  • Phone: 405-388-8545
  • Fax: 888-606-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2003
License Number StateOK

VIII. Authorized Official

Name: KRISTEN SMITH
Title or Position: BUSINESS OWNER AND PRACTITIONER
Credential: OTD, OTR/L
Phone: 405-388-8545