=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205499944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHARINE ANNA SMOLINSKI DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2019
-----------------------------------------------------
Last Update Date | 10/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1959 NE PACIFIC ST
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98195-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-417-1792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2635 ARBOR CIR
-----------------------------------------------------
City | EMMAUS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18049-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-417-1792
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 13354907-1204
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------