Provider Demographics
NPI:1841989456
Name:BACH, KENISHA (OTD)
Entity type:Individual
Prefix:DR
First Name:KENISHA
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18867 GARNET LN
Mailing Address - Street 2:
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-7228
Mailing Address - Country:US
Mailing Address - Phone:605-210-0603
Mailing Address - Fax:
Practice Address - Street 1:505 KANSAS CITY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4146
Practice Address - Country:US
Practice Address - Phone:605-222-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist