Provider Demographics
NPI:1891026480
Name:KEENAN KISNER, NICOLE LEIGH (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEIGH
Last Name:KEENAN KISNER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:1198 W WYLIE AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-1634
Mailing Address - Country:US
Mailing Address - Phone:724-222-2148
Mailing Address - Fax:724-222-6530
Practice Address - Street 1:1198 W WYLIE AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-1634
Practice Address - Country:US
Practice Address - Phone:724-222-2148
Practice Address - Fax:724-222-6530
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005949L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist