Provider Demographics
NPI:1770189748
Name:KEYSTONE PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:KEYSTONE PEDIATRIC THERAPY, LLC
Other - Org Name:KEYSTONE PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AIREAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:513-278-7006
Mailing Address - Street 1:8595 BEECHMONT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-5415
Mailing Address - Country:US
Mailing Address - Phone:513-278-7006
Mailing Address - Fax:513-440-7926
Practice Address - Street 1:8595 BEECHMONT AVE STE 202
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-5415
Practice Address - Country:US
Practice Address - Phone:513-278-7006
Practice Address - Fax:513-440-7926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty