Provider Demographics
NPI:1447926464
Name:SMITH-HUNTER, CARRIE JO
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JO
Last Name:SMITH-HUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 MOUNT HERMON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HERMON
Mailing Address - State:KY
Mailing Address - Zip Code:42157-8043
Mailing Address - Country:US
Mailing Address - Phone:270-427-8790
Mailing Address - Fax:
Practice Address - Street 1:CUMBERLAND VALLEY MANOR
Practice Address - Street 2:301 S MAIN STREET
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717
Practice Address - Country:US
Practice Address - Phone:270-864-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist