Individual
KELLY KISLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2011 W 4TH ST, ONTARIO, OH 44906-1787
(419) 520-2386
Mailing address
DEPT 781629 PO BOX 78000, DETROIT, MI 48278-1629
(614) 355-8004
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002644
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1473276
—
OH
Enumeration date
02/05/2018
Last updated
05/13/2019
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