Individual
MISS KEISHA N. FORDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3903 NORTHDALE BLVD STE 111W, TAMPA, FL 33624-1853
(813) 418-7350
Mailing address
555 AMORY ST, JAMAICA PLAIN, MA 02130-2652
(617) 383-6522
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT16802
FL
225XP0200X
Pediatric Occupational Therapist
10666
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT16802
OTLICENSE
FL
Enumeration date
09/26/2012
Last updated
04/09/2019
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