Healthcare Provider Details

I. General information

NPI: 1104735398
Provider Name (Legal Business Name): EMILY KISER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12034 TANGLEWOOD DR
GLADE SPRING VA
24340-4541
US

IV. Provider business mailing address

184 WYSOR VALLEY RD
HONAKER VA
24260
US

V. Phone/Fax

Practice location:
  • Phone: 276-600-1717
  • Fax: 423-805-1753
Mailing address:
  • Phone: 276-698-6769
  • Fax: 423-805-1753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011588
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: