Provider Demographics
NPI:1053078352
Name:STIEVE, KAITLIN BRIANNE
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:BRIANNE
Last Name:STIEVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 W WISCONSIN AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5720
Mailing Address - Country:US
Mailing Address - Phone:608-393-6110
Mailing Address - Fax:
Practice Address - Street 1:1700 W BENDER RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3852
Practice Address - Country:US
Practice Address - Phone:262-204-5297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3084-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant