Provider Demographics
NPI:1457717167
Name:KEE, KASSANDRA (PTA)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:KEE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 COURT ST
Mailing Address - Street 2:APT 2
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5525
Mailing Address - Country:US
Mailing Address - Phone:207-480-0126
Mailing Address - Fax:
Practice Address - Street 1:33 ROGER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3328
Practice Address - Country:US
Practice Address - Phone:207-784-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA4456225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant