Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | OT14202 | FL |
NPI | 1659643930 |
---|---|
Provider Name | Kaitlyn Mae Cremer Smith |
First Address | Palatka, FL 32177-7775 |
Second Address | Palatka, FL 32177-7775 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2012 |
Last Update Date | 04/08/2014 |