Individual
BROOKE MICHELLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
303 N HURSTBOURNE PKWY, SUITE 200, LOUISVILLE, KY 40222-5185
(502) 412-5847
Mailing address
30 MARCY LN, LOGANSPORT, IN 46947-2400
(574) 727-4399
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
99053601A
IN
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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