Individual
CHRISTINE LEE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
251 FOREST LN, MONTELLO, WI 53949-9380
(608) 297-2153
(608) 297-9328
Mailing address
N6835 RAYMOND RD, PARDEEVILLE, WI 53954-9595
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1415-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40815800
—
WI
Enumeration date
03/21/2007
Last updated
09/10/2012
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