Provider Demographics
NPI:1992982326
Name:KEELEN, KEISHA LISETTE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:LISETTE
Last Name:KEELEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 141ST ST
Mailing Address - Street 2:APT 52
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W 141ST ST
Practice Address - Street 2:APT 52
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1808
Practice Address - Country:US
Practice Address - Phone:877-835-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006620-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist