Provider Demographics
NPI:1114671351
Name:SEXTON, KEIRRA LOUISE (COTA/L)
Entity Type:Individual
Prefix:
First Name:KEIRRA
Middle Name:LOUISE
Last Name:SEXTON
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 1:5220 SPRING VALLEY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-1944
Mailing Address - Country:US
Mailing Address - Phone:469-291-8500
Mailing Address - Fax:
Practice Address - Street 1:1000 SAINT LOUIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3377
Practice Address - Country:US
Practice Address - Phone:817-921-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2024-02-26
Deactivation Date:2024-02-05
Deactivation Code:
Reactivation Date:2024-02-26
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX218242224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty