Provider Demographics
NPI:1649573445
Name:CLOSE, RONALD KEITH II (COTA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:KEITH
Last Name:CLOSE
Suffix:II
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BEAR MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-1806
Mailing Address - Country:US
Mailing Address - Phone:304-617-5844
Mailing Address - Fax:
Practice Address - Street 1:122 BEAR MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-1806
Practice Address - Country:US
Practice Address - Phone:304-617-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC 1756225X00000X
MDA01808224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist