Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31006148A | IN |
N | 225X00000X | Occupational Therapist | 4197 | TN |
N | 225X00000X | Occupational Therapist | OT2407 | MS |
NPI | 1003112111 |
---|---|
Provider Name | Caitlin Smedema |
First Address | Austell, GA 30106-1121 |
Second Address | Lafayette, IN 47905-4972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2011 |
Last Update Date | 06/11/2020 |