Provider Demographics
NPI:1477245611
Name:SIEREVELD, KALIE MARIE
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:MARIE
Last Name:SIEREVELD
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 1:6825 CORKWOOD KNL
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8580
Mailing Address - Country:US
Mailing Address - Phone:513-309-7376
Mailing Address - Fax:
Practice Address - Street 1:6825 CORKWOOD KNL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8580
Practice Address - Country:US
Practice Address - Phone:513-309-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0067942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer