Provider Demographics
NPI:1417281429
Name:KEACH, REBECCA J (OT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:KEACH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3722
Mailing Address - Country:US
Mailing Address - Phone:812-372-8447
Mailing Address - Fax:812-375-5388
Practice Address - Street 1:2100 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3722
Practice Address - Country:US
Practice Address - Phone:812-372-8447
Practice Address - Fax:812-375-5388
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003537A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist