Provider Demographics
NPI:1891438255
Name:CHARLES, KEISHA M (OT)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:M
Last Name:CHARLES
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 1:122 TOWNHOUSE RD N
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1276
Mailing Address - Country:US
Mailing Address - Phone:516-514-5098
Mailing Address - Fax:
Practice Address - Street 1:122 TOWNHOUSE RD N
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1276
Practice Address - Country:US
Practice Address - Phone:516-514-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty