Provider Demographics
NPI:1639341845
Name:BURRINGTON, KEISHA DAUPHIN (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:DAUPHIN
Last Name:BURRINGTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:DAUPHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1747 SUNSET PALM DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-8185
Mailing Address - Country:US
Mailing Address - Phone:321-945-9974
Mailing Address - Fax:
Practice Address - Street 1:1337 S INTERNATIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1402
Practice Address - Country:US
Practice Address - Phone:407-804-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 10651224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant