Provider Demographics
NPI:1861722431
Name:KIEHM, MELANIE LIISA (OTR/L)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LIISA
Last Name:KIEHM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LIISA
Other - Last Name:MILBRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 HIGHWAY 53
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOK
Mailing Address - State:MN
Mailing Address - Zip Code:55723-5102
Mailing Address - Country:US
Mailing Address - Phone:218-666-2697
Mailing Address - Fax:218-666-2620
Practice Address - Street 1:221 HIGHWAY 53
Practice Address - Street 2:SUITE D
Practice Address - City:COOK
Practice Address - State:MN
Practice Address - Zip Code:55723-5102
Practice Address - Country:US
Practice Address - Phone:218-666-2697
Practice Address - Fax:218-666-2620
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist