Provider Demographics
NPI:1447706403
Name:KISNER MCGRAW HAND TO SHOULDER REHABILITATION
Entity type:Organization
Organization Name:KISNER MCGRAW HAND TO SHOULDER REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:KISNER MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L, CHT
Authorized Official - Phone:304-216-9298
Mailing Address - Street 1:105 MAPLE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4081
Mailing Address - Country:US
Mailing Address - Phone:304-216-9298
Mailing Address - Fax:304-291-2998
Practice Address - Street 1:26 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-3858
Practice Address - Country:US
Practice Address - Phone:304-241-1219
Practice Address - Fax:304-322-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV886261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine