Provider Demographics
NPI:1134685894
Name:HALL KEATOR, HEATHER ELAINE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELAINE
Last Name:HALL KEATOR
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 DORIS CT
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9153
Mailing Address - Country:US
Mailing Address - Phone:502-718-2408
Mailing Address - Fax:
Practice Address - Street 1:6620 DORIS CT
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-9153
Practice Address - Country:US
Practice Address - Phone:502-718-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006177A225X00000X
KY164271225X00000X
KYBOTOCT02218362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist