Individual
MRS. JAIME STOREY KIESOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
85 MIDDLE RD, CUMBERLAND, ME 04021-3707
(207) 829-8007
(207) 829-8008
Mailing address
85 MIDDLE RD, CUMBERLAND, ME 04021-3707
(207) 829-8007
(207) 829-8008
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT1178
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133260099
—
ME
Enumeration date
01/18/2007
Last updated
04/05/2019
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