Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 104837 | MN |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0968 | SD |
NPI | 1134671613 |
---|---|
Provider Name | Kelcey Smith |
First Address | Brandon, SD 57005-6690 |
Second Address | Brandon, SD 57005-6690 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2016 |
Last Update Date | 31/10/2016 |