Individual
KRISTA M LIESER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1306 GEMINI CIR, SUITE 3, OTTAWA, IL 61350-1694
(815) 431-9980
(815) 431-9981
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056-002942
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00855683
MEDICARE RR
IL
Enumeration date
03/08/2010
Last updated
10/06/2014
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