Provider Demographics
NPI:1073050803
Name:KEOUGH, NORA (COTA/L)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:KEOUGH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W POPLAR ST
Mailing Address - Street 2:REHAB SERVICES
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2846
Mailing Address - Country:US
Mailing Address - Phone:509-897-3320
Mailing Address - Fax:509-897-5752
Practice Address - Street 1:401 W POPLAR ST
Practice Address - Street 2:REBAB SERVICE
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2846
Practice Address - Country:US
Practice Address - Phone:509-897-2100
Practice Address - Fax:509-897-5752
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 00001076224Z00000X
OR1029288224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant