Individual
MICHELLE M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
20910 SR 410 E, BONNEY LAKE, WA 98391-6302
(253) 862-2575
Mailing address
10722 440TH ST E, EATONVILLE, WA 98328-8027
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT00003457
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0193789
L&
WA
05
—
8381857
—
WA
Enumeration date
06/27/2006
Last updated
07/21/2022
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