| Doctor Name: | MR. MICHELLE RENEE SMYTH |
| NPI Number: | 1699744680 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OT |
| License Number: | KY-R2835 |
| Business Practice Address: | 1650 Cochrane Cir Fort Carson, CO - 809134603 |
| Business Phone Number: | 7195267110 |
| Business Fax Number: | |
| Mailing Address: | 3114 Capstan Way, COLORADO SPRINGS |
| State: | CO |
| Postal Code: | 809068513 |
| Phone Number: | 7196417346 |
| Fax Number: | |
| NPI Enumeration Date: | 03/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | KY-R2835 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |