| Doctor Name: | KRISTEN S. WIESE |
| NPI Number: | 1841473527 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, OTR/L |
| License Number: | 2414 |
| Business Practice Address: | 608 Bledsoe Rd Nw Los Ranchos, NM - 871076219 |
| Business Phone Number: | 5059080717 |
| Business Fax Number: | |
| Mailing Address: | 1104 Salamanca St Nw, ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871075626 |
| Phone Number: | 5059080717 |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2007 |
| NPI Last Update Date: | 04/12/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1300X |
| License Number: | 2414 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Human Factors |
| Taxonomy Definition: | |