Kenneth Wayne Smith, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA-1091 Issued in ID

Practice address

12046 W Spring River CT
Boise, ID 83709-5160

Phone

(208) 968-4302

NPI assigned

Sep 27, 2011

Last updated

Sep 27, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317081600000",
    "number": "1740563634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12046 W SPRING RIVER CT",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837095160",
            "telephone_number": "208-968-4302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12046 W SPRING RIVER CT",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837095160",
            "telephone_number": "208-968-4302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-27",
        "last_updated": "2011-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "ID",
            "license": "OTA-1091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Rose Smith, M.S., CF-SLP
• Kameryn Loraine Smith
• Kapka Zlatkova Smith, LMSW
• Kathryn G Smith, LMT
• Kelsey Hamilton Smith, NP
• Kevin James Smith, LMSW
• Kristie Opal Smith, AUD
• Laura Kay Smith, DTR
• Lauren Abigail Smith
• Lauren Elise Smith, MS

• Occupational Therapy Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Occupational Therapy Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.