Provider Demographics
NPI:1518533561
Name:KIEL, MARTHA MARILYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARILYN
Last Name:KIEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:MARILYN
Other - Last Name:BRISCOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:2615 N DOWNER AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4245
Practice Address - Country:US
Practice Address - Phone:414-962-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15423-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist