Provider Demographics
NPI:1447656350
Name:KIRKING, KIERSTEN
Entity type:Individual
Prefix:MISS
First Name:KIERSTEN
Middle Name:
Last Name:KIRKING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W. RAINDBOW RIDGE DR.
Mailing Address - Street 2:1207
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154
Mailing Address - Country:US
Mailing Address - Phone:715-577-5793
Mailing Address - Fax:
Practice Address - Street 1:210 W. RAINDBOW RIDGE DR.
Practice Address - Street 2:1207
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154
Practice Address - Country:US
Practice Address - Phone:715-577-5793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist