Healthcare Provider Details

I. General information

NPI: 1124913843
Provider Name (Legal Business Name): KRISTY J KEITH M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S MILLIKEN AVE STE 508
ONTARIO CA
91761-2337
US

IV. Provider business mailing address

1420 S MILLIKEN AVE STE 508
ONTARIO CA
91761-2337
US

V. Phone/Fax

Practice location:
  • Phone: 909-983-2020
  • Fax:
Mailing address:
  • Phone: 909-983-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number20453
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number41503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: