Provider Demographics
NPI:1114766417
Name:BALL, KEISHA DAWN (RRT)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:DAWN
Last Name:BALL
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 THATCHER RD
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-8607
Mailing Address - Country:US
Mailing Address - Phone:406-925-9969
Mailing Address - Fax:
Practice Address - Street 1:200 N OREGON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3624
Practice Address - Country:US
Practice Address - Phone:406-683-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRCP-RCP-LIC-985227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty