Provider Demographics
NPI:1912328311
Name:KEYSER, WILLIAM KEITH
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KEITH
Last Name:KEYSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3435
Mailing Address - Country:US
Mailing Address - Phone:509-301-5733
Mailing Address - Fax:
Practice Address - Street 1:534 BOYER AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2047
Practice Address - Country:US
Practice Address - Phone:509-525-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60127045224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant