Provider Demographics
NPI:1245928332
Name:SMITH, KATHERINE PAIGE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:PAIGE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:PAIGE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15121 TRADITIONS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-562-3485
Mailing Address - Fax:405-562-3495
Practice Address - Street 1:15121 TRADITIONS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-562-3485
Practice Address - Fax:405-562-3495
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1824225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics