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General NPI Number Information
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NPI Number | 1891026480
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Entity Type | Individual
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Provider Name | NICOLE LEIGH KEENAN KISNER MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 1198 W WYLIE AVE
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City | WASHINGTON
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State | PA
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Zip | 15301-1634
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Country | US
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Telephone | 724-222-2148
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Fax | 724-222-6530
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Provider Business Mailing Address
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Address Line | 1198 W WYLIE AVE
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City | WASHINGTON
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State | PA
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Zip | 15301-1634
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Country | US
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Telephone | 724-222-2148
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Fax | 724-222-6530
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC005949L
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License Number State | PA
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