Provider Demographics
NPI:1962027318
Name:SIEVERS, KIMBERLY A
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:SIEVERS
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 1:10198 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:WI
Mailing Address - Zip Code:54412-9636
Mailing Address - Country:US
Mailing Address - Phone:715-305-5166
Mailing Address - Fax:
Practice Address - Street 1:10198 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:WI
Practice Address - Zip Code:54412-9636
Practice Address - Country:US
Practice Address - Phone:715-305-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6866590OtherPATH INTERNATIONAL