Provider Demographics
NPI:1730541541
Name:MOHOLY, KIERSTEN (MOTR/L)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:MOHOLY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-1133
Mailing Address - Country:US
Mailing Address - Phone:509-782-3355
Mailing Address - Fax:
Practice Address - Street 1:210 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1133
Practice Address - Country:US
Practice Address - Phone:509-782-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2869225X00000X
IDOT-1344225X00000X
WA60859193225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist