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General NPI Number Information
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NPI Number | 1598840084
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Entity Type | Individual
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Provider Name | RICHARD K. SMITH CTRS,WOSH
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1139 HUNTINGTON DR
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-4516
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Country | US
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Telephone | 310-478-3711
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Fax | 310-268-3279
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Provider Business Mailing Address
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Address Line | 1139 HUNTINGTON DR
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-4516
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Country | US
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Telephone | 310-478-3711
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Fax | 310-268-3279
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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 | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 32086
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License Number State | NY
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