Provider Demographics
NPI:1922739002
Name:NIEVES, KEYSA JANICE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KEYSA
Middle Name:JANICE
Last Name:NIEVES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARJORIE LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2079
Mailing Address - Country:US
Mailing Address - Phone:860-918-6985
Mailing Address - Fax:
Practice Address - Street 1:142 COOPER AVE
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06089
Practice Address - Country:US
Practice Address - Phone:860-317-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5937225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist