Provider Demographics
NPI:1497793293
Name:FIESELER, KELLY CHRISTINE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CHRISTINE
Last Name:FIESELER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23580 SHAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-2605
Mailing Address - Country:US
Mailing Address - Phone:216-491-8407
Mailing Address - Fax:
Practice Address - Street 1:23580 SHAKER BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-2605
Practice Address - Country:US
Practice Address - Phone:216-491-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT96112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34190772200OtherWORKERS COMPENSATION
OH341907722OtherUNITED HEALTHCARE
OH2382505Medicaid
OH000000247980OtherANTHEM
OH2382505Medicaid