Provider Demographics
NPI:1487967402
Name:KIVI, DEANNE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:MARIE
Last Name:KIVI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:MARIE
Other - Last Name:PROCHASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:677 ANNE ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4390
Mailing Address - Country:US
Mailing Address - Phone:218-444-8280
Mailing Address - Fax:
Practice Address - Street 1:677 ANNE ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4390
Practice Address - Country:US
Practice Address - Phone:218-444-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist