MEDICARE: KEESHA N BASEL OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	1702201	KS

General Provider Information

NPI Number	:	1760506646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEESHA N BASEL OTR

Provider Business Mailing Address
First Line	:	13151 NEBRASKA AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4563
Country	:	US
Telephone Number	:	913-721-0292
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 COLORADO BLVD
Second Line	:	#318
City	:	DENVER
State	:	CO
Zip	:	80206-4084
Country	:	US
Telephone Number	:	866-801-9492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2007
Last Update Date	:	07/08/2007

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Directions to “ KEESHA N BASEL OTR” Practice Location

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