Provider Demographics
NPI:1598374001
Name:KISLOWSKI, KELLY MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:KISLOWSKI
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 JAMES CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-6609
Mailing Address - Country:US
Mailing Address - Phone:219-789-3925
Mailing Address - Fax:
Practice Address - Street 1:8626 WICKER AVE STE C
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9053
Practice Address - Country:US
Practice Address - Phone:219-440-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist