Provider Demographics
NPI:1336308253
Name:YANCEY, KEITH BOYCE (OTR)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:BOYCE
Last Name:YANCEY
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-5859
Mailing Address - Country:US
Mailing Address - Phone:360-423-4060
Mailing Address - Fax:360-578-5983
Practice Address - Street 1:128 BEACON HILL DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-5859
Practice Address - Country:US
Practice Address - Phone:360-423-4060
Practice Address - Fax:360-578-5983
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist