Provider Demographics
NPI:1306986583
Name:KIEFER, DANA MEREDITH (MA OTRL)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MEREDITH
Last Name:KIEFER
Suffix:
Gender:F
Credentials:MA OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3803
Mailing Address - Country:US
Mailing Address - Phone:631-767-6554
Mailing Address - Fax:631-447-1621
Practice Address - Street 1:7 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3803
Practice Address - Country:US
Practice Address - Phone:631-767-6554
Practice Address - Fax:631-447-1621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist