Provider Demographics
NPI:1144975327
Name:KIEL, BRENDAN JOSEPH (MSOT, OTRL)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:JOSEPH
Last Name:KIEL
Suffix:
Gender:M
Credentials:MSOT, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 BROWN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-8721
Mailing Address - Country:US
Mailing Address - Phone:989-640-8479
Mailing Address - Fax:
Practice Address - Street 1:2530 MARFITT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6343
Practice Address - Country:US
Practice Address - Phone:517-777-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist