Provider Demographics
NPI:1336386168
Name:BAHETI, KEIRA F
Entity Type:Individual
Prefix:
First Name:KEIRA
Middle Name:F
Last Name:BAHETI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEIRA
Other - Middle Name:F
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 EAGLE ROCK AVENUE
Mailing Address - Street 2:SUTIE 201
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:
Practice Address - Street 1:11 EAGLE ROCK AVENUE
Practice Address - Street 2:SUTIE 201
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936
Practice Address - Country:US
Practice Address - Phone:973-887-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00472500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist