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General NPI Number Information
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NPI Number | 1154962082
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Entity Type | Individual
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Provider Name | KIM M SMITH
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Gender | Female
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 611 SW FEDERAL HWY STE C
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City | STUART
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State | FL
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Zip | 34994-2925
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Country | US
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Telephone | 772-497-4186
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Fax | 772-692-7253
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Provider Business Mailing Address
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Address Line | 3240 SW ISLAND WAY
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City | PALM CITY
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State | FL
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Zip | 34990-1410
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Country | US
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Telephone | 772-220-3393
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT10073
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License Number State | FL
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