Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1841868023 |
---|---|
Provider Name | Dr. Nathan Henry Kies |
First Address | Crestwood, IL 60418-1498 |
Second Address | Dyer, IN 46311-1588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/06/2021 |