Individual
KEISHA DESHEA MIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
181 OLD WHITLEY RD, LONDON, KY 40744-8211
(606) 330-0223
Mailing address
368 OXFORD CIR, RICHMOND, KY 40475-8263
(606) 733-5299
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
264348
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264348
KY STATE LICENSE
KY
Enumeration date
07/29/2020
Last updated
04/21/2021
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