Keisha Formanek, COTA/L
Individual provider Active NPI Occupational Therapy Assistant · West Union, IA
NPI 1073322103 · NPPES record last updated Jan 3, 2025
Key facts
- NPI
- 1073322103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 080424 (IA)
- Practice address
- 112 Jefferson St
West Union, IA 52175-1022 - Phone
- (563) 422-3811
- NPI assigned
- Jan 3, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 080424 | IA | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 080424 | IA | Yes |
Addresses
Primary practice location
112 Jefferson St
West Union, IA 52175-1022
Mailing address
112 Jefferson St
West Union, IA 52175-1022
Other providers in West Union, IA
- Marin Ehler
- Eickert Chiropractic Clinic PLLC
- Cameron John Elmer
- Fayette County Case Management
- Gabrielle Icele Flynt
- Karen Louise Foster
- Jennifer Brekke Fuentes
- Garvin Moser LLC
- Good Samaritan Center
- GRX Holdings, LLC
All providers in West Union, IA · Occupational Therapy Assistant in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.