Healthcare Provider Details

I. General information

NPI: 1346451283
Provider Name (Legal Business Name): KIERSTEN A SMITH MOTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FORT VANCOUVER CONVALESCENT CENTER 8507 NE 8TH WAY
VANCOUVER WA
98664
US

IV. Provider business mailing address

21018 NE 212TH AVE
BATTLE GROUND WA
98604-9617
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-5335
  • Fax: 360-892-2086
Mailing address:
  • Phone: 360-687-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003454
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1056214
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: