Provider Demographics
NPI:1801139399
Name:KIEL, MELISSA LOUISE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LOUISE
Last Name:KIEL
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 1:8328 VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457-9141
Mailing Address - Country:US
Mailing Address - Phone:810-288-5496
Mailing Address - Fax:
Practice Address - Street 1:8328 VIENNA RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457-9141
Practice Address - Country:US
Practice Address - Phone:810-288-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087293171M00000X
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No171M00000XOther Service ProvidersCase Manager/Care Coordinator