Provider Demographics
NPI:1902380934
Name:HIEB, KELSEY ANNE (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ANNE
Last Name:HIEB
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 BLUE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3649
Mailing Address - Country:US
Mailing Address - Phone:307-299-0499
Mailing Address - Fax:
Practice Address - Street 1:851 WERNER CT STE 100
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1308
Practice Address - Country:US
Practice Address - Phone:307-234-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist