Provider Demographics
NPI:1396131702
Name:PATTERSON, KEISHA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:3863 HIGHWAY 138 SE # 1062
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4143
Mailing Address - Country:US
Mailing Address - Phone:205-603-6929
Mailing Address - Fax:
Practice Address - Street 1:3863 HIGHWAY 138 SE # 1062
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4143
Practice Address - Country:US
Practice Address - Phone:205-603-6929
Practice Address - Fax:470-329-0029
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3936225X00000X
GAOT007371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist