Provider Demographics
NPI:1356990824
Name:SMITH, KRISTINE (ORT/L)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ORT/L
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:DOSKOCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2385 S MARION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5103
Mailing Address - Country:US
Mailing Address - Phone:817-229-0225
Mailing Address - Fax:
Practice Address - Street 1:6767 S SPRUCE ST STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6118
Practice Address - Country:US
Practice Address - Phone:303-997-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002874225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist