MEDICARE: MS. KAITLYN BRIANNE SMART 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
1	225X00000X	Occupational Therapist	OT008388	GA

General Provider Information

NPI Number	:	1881335974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAITLYN BRIANNE SMART OTR/L

Provider Business Mailing Address
First Line	:	1012 OVERBROOK DR
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-1209
Country	:	US
Telephone Number	:	828-447-9209
Fax Number	:

Provider Business Practice Location Address
First Line	:	4875 HOG MOUNTAIN RD
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3476
Country	:	US
Telephone Number	:	678-828-8584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/05/2022

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