Provider Demographics
NPI:1477787166
Name:KESTI, SUSAN R (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:KESTI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 CARSON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45205-1726
Mailing Address - Country:US
Mailing Address - Phone:513-448-5000
Mailing Address - Fax:
Practice Address - Street 1:1116 CARSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-1726
Practice Address - Country:US
Practice Address - Phone:513-448-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14127225700000X
WAMA00023462225700000X
CA4590225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist