Les John Kiesel, OTR

Individual provider Active NPI Occupational Therapist · Dale, IN

NPI 1982802682 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1982802682
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapist 225X00000X
License
31001496A (IN)
Practice address
404 West Willow Road
Dale, IN 47523
Phone
(812) 937-4489
Fax
(812) 937-7101
NPI assigned
Jul 5, 2007
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
31001496AINMDOccupational Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 31001496A IN Yes

Addresses

Primary practice location

404 West Willow Road
Dale, IN 47523

Mailing address

10685 S 310 W
Haubstadt, IN 47639
Phone (812) 937-4489

Other providers in Dale, IN

All providers in Dale, IN · Occupational Therapist in Indiana

Sources for this page

Verify at the official NPI Registry.