Provider Demographics
NPI:1831473347
Name:KIECK, DOROTHY ANN
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:ANN
Last Name:KIECK
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 1:5786 DALTON DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-9329
Mailing Address - Country:US
Mailing Address - Phone:585-905-1743
Mailing Address - Fax:
Practice Address - Street 1:131 DRUMLIN CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1863
Practice Address - Country:US
Practice Address - Phone:315-548-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004848-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004848-1OtherSTATE LICENCE