Provider Demographics
NPI:1760506646
Name:BASEL, KEESHA N (OTR)
Entity Type:Individual
Prefix:
First Name:KEESHA
Middle Name:N
Last Name:BASEL
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 1:13151 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4563
Mailing Address - Country:US
Mailing Address - Phone:913-721-0292
Mailing Address - Fax:
Practice Address - Street 1:700 COLORADO BLVD
Practice Address - Street 2:#318
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4084
Practice Address - Country:US
Practice Address - Phone:866-801-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1702201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist