Provider Demographics
NPI:1407361603
Name:DUMONT, KEITH (OTR/L)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:DUMONT
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 W END AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4352
Mailing Address - Country:US
Mailing Address - Phone:516-680-2443
Mailing Address - Fax:
Practice Address - Street 1:725 KAPIOLANI BLVD STE C103
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6027
Practice Address - Country:US
Practice Address - Phone:808-596-4650
Practice Address - Fax:808-596-4651
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT-1669225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation