Provider Demographics
NPI:1336818053
Name:TIERNEY, KAILEE
Entity Type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:TIERNEY
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 1:1 STILES RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4804
Mailing Address - Country:US
Mailing Address - Phone:855-390-7774
Mailing Address - Fax:855-734-4666
Practice Address - Street 1:110 HAVERHILL RD STE 101
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2139
Practice Address - Country:US
Practice Address - Phone:855-390-7774
Practice Address - Fax:855-734-4666
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13911OtherMA STATE OTR/L LICENSE