Provider Demographics
NPI:1154708725
Name:RATHBONE, KEISHA
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:
Last Name:RATHBONE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-3518
Mailing Address - Country:US
Mailing Address - Phone:918-906-1248
Mailing Address - Fax:
Practice Address - Street 1:1306 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4205
Practice Address - Country:US
Practice Address - Phone:918-251-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-02
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist