Provider Demographics
NPI:1053925925
Name:KACIAN, AUTUMN (NBC-HWC, LMT)
Entity type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:
Last Name:KACIAN
Suffix:
Gender:F
Credentials:NBC-HWC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 57TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-2392
Mailing Address - Country:US
Mailing Address - Phone:412-327-4987
Mailing Address - Fax:
Practice Address - Street 1:1360 OLD FREEPORT RD STE 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-4102
Practice Address - Country:US
Practice Address - Phone:412-772-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001689225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist