Provider Demographics
NPI:1245382670
Name:KEITH, KATHLEEN NEOLA (OTR)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:NEOLA
Last Name:KEITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 COLLYER ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3412
Mailing Address - Country:US
Mailing Address - Phone:303-667-5577
Mailing Address - Fax:
Practice Address - Street 1:611 KORTE WAY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6366
Practice Address - Country:US
Practice Address - Phone:303-776-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
998259225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42954720Medicare ID - Type Unspecified