Provider Demographics
NPI:1588879522
Name:PARTRIDGE, KEITH ROBERT (COTA)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ROBERT
Last Name:PARTRIDGE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BUTLER ST
Mailing Address - Street 2:APT # 2
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1351
Mailing Address - Country:US
Mailing Address - Phone:508-259-6594
Mailing Address - Fax:
Practice Address - Street 1:39 BUTLER ST
Practice Address - Street 2:APT # 2
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1351
Practice Address - Country:US
Practice Address - Phone:508-259-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2506224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant