Provider Demographics
NPI:1841868023
Name:KIES, NATHAN HENRY (OTD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:HENRY
Last Name:KIES
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 135TH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60418-1498
Mailing Address - Country:US
Mailing Address - Phone:815-922-4855
Mailing Address - Fax:
Practice Address - Street 1:1532 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1588
Practice Address - Country:US
Practice Address - Phone:219-515-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology