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NPI Code Detail

MEDICARE: KRISTINA SMITH

MEDICARE: KRISTINA SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1558910455
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA SMITH
Provider Business Mailing Address
First Line : 2400 SCIENCE PKWY
Second Line :
City : OKEMOS
State : MI
Zip : 48864-2560
Country : US
Telephone Number : 517-374-8066
Fax Number :
Provider Business Practice Location Address
First Line : 1220 W PARNALL RD
Second Line :
City : JACKSON
State : MI
Zip : 49201-7071
Country : US
Telephone Number : 517-513-3297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2019
Last Update Date : 09/04/2019

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Directions to “ KRISTINA SMITH ” Practice Location

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