Provider Demographics
NPI:1881233310
Name:BELL, KEISHA MEKEBA
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:MEKEBA
Last Name:BELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24258 SARGENT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3939
Mailing Address - Country:US
Mailing Address - Phone:248-945-1130
Mailing Address - Fax:
Practice Address - Street 1:24258 SARGENT AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3939
Practice Address - Country:US
Practice Address - Phone:248-945-1130
Practice Address - Fax:248-945-1130
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5201004578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist