Individual
KEISHA FORMANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
112 JEFFERSON ST, WEST UNION, IA 52175-1022
(563) 422-3811
Mailing address
112 JEFFERSON ST, WEST UNION, IA 52175-1022
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
080424
IA
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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