Provider Demographics
NPI:1386379287
Name:SMITH, KATHLEEN FAYTHE (MOTR/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FAYTHE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219297
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9297
Mailing Address - Country:US
Mailing Address - Phone:816-241-2131
Mailing Address - Fax:816-241-0551
Practice Address - Street 1:1931 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3407
Practice Address - Country:US
Practice Address - Phone:816-241-2131
Practice Address - Fax:816-241-0551
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022002793225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist