Provider Demographics
NPI:1881209914
Name:KIESSLING, ERICA BROOKE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:BROOKE
Last Name:KIESSLING
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 1:1606 LAKE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-6947
Mailing Address - Country:US
Mailing Address - Phone:919-612-1242
Mailing Address - Fax:
Practice Address - Street 1:402 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1511
Practice Address - Country:US
Practice Address - Phone:540-828-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer