Healthcare Provider Details

I. General information

NPI: 1114766417
Provider Name (Legal Business Name): KEISHA DAWN BALL RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N OREGON ST
DILLON MT
59725-3624
US

IV. Provider business mailing address

609 THATCHER RD
DILLON MT
59725-8607
US

V. Phone/Fax

Practice location:
  • Phone: 406-683-5105
  • Fax:
Mailing address:
  • Phone: 406-925-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP-RCP-LIC-985
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: