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General NPI Number Information
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NPI Number | 1780958769
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Entity Type | Individual
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Provider Name | KELLY M SMITH B.S., C.B.I.S. EXP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 2880 RENFREW ST.
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City | ANN ARBOR
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State | MI
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Zip | 48105-1454
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Country | US
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Telephone | 734-649-6749
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Fax |
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Provider Business Mailing Address
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Address Line | 11415 LAUDERDALE CT
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City | PINCKNEY
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State | MI
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Zip | 48169-9535
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Country | US
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Telephone | 734-878-2919
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 1018
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 1018
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License Number State | MI
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