Provider Demographics
NPI:1659005213
Name:KIEHL, RUTHANN
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:
Last Name:KIEHL
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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MO
Mailing Address - Zip Code:63461-0208
Mailing Address - Country:US
Mailing Address - Phone:573-769-6166
Mailing Address - Fax:573-769-2356
Practice Address - Street 1:1219 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:MO
Practice Address - Zip Code:63461-1943
Practice Address - Country:US
Practice Address - Phone:573-769-6166
Practice Address - Fax:573-769-2356
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022025900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation