Individual
KIMBERLY KISNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
36457 N GANTZEL RD, SAN TAN VALLEY, AZ 85140-7342
(480) 784-3270
Mailing address
36457 N GANTZEL RD, SAN TAN VALLEY, AZ 85140-7342
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7323
AZ
Other
Enumeration date
01/22/2018
Last updated
01/22/2018
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