Provider Demographics
NPI:1992203681
Name:MACISAAC, CYNTHIA KUEHNLE
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:KUEHNLE
Last Name:MACISAAC
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:JANE
Other - Last Name:KUEHNLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1851 SILVER EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-9757
Mailing Address - Country:US
Mailing Address - Phone:719-486-1689
Mailing Address - Fax:
Practice Address - Street 1:1851 SILVER EAGLE CIR
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-9757
Practice Address - Country:US
Practice Address - Phone:970-406-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-27
Last Update Date:2018-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0001785225X00000X
CO0001785225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist