Healthcare Provider Details

I. General information

NPI: 1730346610
Provider Name (Legal Business Name): CHERIE CASING KEOGH-DODGE M.A., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERIE CASING KEOGH M.A., OTR/L

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 BLUE JAY DR
LIBERTY MO
64068-1977
US

IV. Provider business mailing address

2609 GLENN HENDREN DR
LIBERTY MO
64068
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-2315
  • Fax: 816-407-1555
Mailing address:
  • Phone: 816-407-4555
  • Fax: 816-781-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5067-026
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number9759
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number13354
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2014034968
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: