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NPI Code Detail

MEDICARE: KELLI LEE SMITH OTR/L

MEDICARE: KELLI LEE SMITH OTR/L
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
1225X00000XOccupational Therapist10025CA

General Provider Information

NPI Number : 1649409178
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI LEE SMITH OTR/L
Provider Business Mailing Address
First Line : 5220 W 104TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-6102
Country : US
Telephone Number : 888-711-6272
Fax Number :
Provider Business Practice Location Address
First Line : 5220 W 104TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-6102
Country : US
Telephone Number : 888-711-6272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2009
Last Update Date : 07/06/2009

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Directions to “ KELLI LEE SMITH OTR/L” Practice Location

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