Healthcare Provider Details

I. General information

NPI: 1912750142
Provider Name (Legal Business Name): KIELA BRIDGE MOT, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FORBES RD STE 1120
BRAINTREE MA
02184-2705
US

IV. Provider business mailing address

220 FORBES RD STE 1120
BRAINTREE MA
02184-2705
US

V. Phone/Fax

Practice location:
  • Phone: 617-322-2694
  • Fax:
Mailing address:
  • Phone: 617-322-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL15319
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3562
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: