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General NPI Number Information
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NPI Number | 1336655588
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Entity Type | Individual
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Provider Name | KAITLYN ELIZABETH SMITH OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 222 DEERWOOD DR
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-3145
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Country | US
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Telephone | 315-638-6124
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Fax |
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Provider Business Mailing Address
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Address Line | 112 FOREST VIEW LN
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City | MINOA
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State | NY
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Zip | 13116-1937
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Country | US
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Telephone | 315-985-5156
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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 | 022035
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License Number State | NY
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