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NPI Code Detail

MEDICARE: MRS. JAIME STOREY KIESOW OTR/L

MEDICARE: MRS. JAIME STOREY KIESOW OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational TherapistOT1178ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659424380
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAIME STOREY KIESOW OTR/L
Provider Business Mailing Address
First Line : 85 MIDDLE RD
Second Line :
City : CUMBERLAND
State : ME
Zip : 04021-3707
Country : US
Telephone Number : 207-829-8007
Fax Number : 207-829-8008
Provider Business Practice Location Address
First Line : 85 MIDDLE RD
Second Line :
City : CUMBERLAND
State : ME
Zip : 04021-3707
Country : US
Telephone Number : 207-829-8007
Fax Number : 207-829-8008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 04/05/2019

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