Provider Demographics
NPI:1396162640
Name:DYKSTRA, KIERSTEN (OTR/L, PA-C)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:OTR/L, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 FRANKLIN AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2739
Mailing Address - Country:US
Mailing Address - Phone:724-396-8586
Mailing Address - Fax:
Practice Address - Street 1:300 HALKET ST STE 4500
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-641-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013274225XP0200X
363AM0700X
PAOA003886363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics