Provider Demographics
NPI:1043563984
Name:KESHISHYAN, EDIT KATHY (OT)
Entity Type:Individual
Prefix:MS
First Name:EDIT
Middle Name:KATHY
Last Name:KESHISHYAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-3424
Mailing Address - Country:US
Mailing Address - Phone:818-288-3334
Mailing Address - Fax:
Practice Address - Street 1:1018 ELM AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-3424
Practice Address - Country:US
Practice Address - Phone:818-288-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist