=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104735398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY KISER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2026
-----------------------------------------------------
Last Update Date | 09/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12034 TANGLEWOOD DR
-----------------------------------------------------
City | GLADE SPRING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24340-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-600-1717
-----------------------------------------------------
Fax | 423-805-1753
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 184 WYSOR VALLEY RD
-----------------------------------------------------
City | HONAKER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-698-6769
-----------------------------------------------------
Fax | 423-805-1753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119011588
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------