Provider Demographics
NPI:1942937404
Name:KIESER, JAMIE NICHOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICHOLE
Last Name:KIESER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:NICHOLE
Other - Last Name:HOFFMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 S DORSEY LN APT 2024
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-7022
Mailing Address - Country:US
Mailing Address - Phone:309-712-6263
Mailing Address - Fax:
Practice Address - Street 1:1675 E MELROSE ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1001
Practice Address - Country:US
Practice Address - Phone:480-964-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ008887225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist