Provider Demographics
NPI:1023603180
Name:KIEL, SARA (LMT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KIEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 W COLLEGE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3948
Mailing Address - Country:US
Mailing Address - Phone:619-804-4218
Mailing Address - Fax:
Practice Address - Street 1:125 CENTRAL AVE # 1A-3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9619
Practice Address - Country:US
Practice Address - Phone:619-804-4218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist