Individual
KEITH STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
13375 UNIVERSITY AVE, SUITE 300, CLIVE, IA 50325-8261
(515) 327-1454
(515) 327-1458
Mailing address
205 W WACKER DR, SUITE 1020, CHICAGO, IL 60606-1216
(312) 640-0329
(312) 640-0407
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
01633
IA
Other
Enumeration date
12/17/2013
Last updated
10/29/2015
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