Provider Demographics
NPI:1144968843
Name:FIELDS KEELS, ERICA (COTA)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:FIELDS KEELS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RYERS AVE
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-2212
Mailing Address - Country:US
Mailing Address - Phone:267-368-0064
Mailing Address - Fax:
Practice Address - Street 1:5 RYERS AVE
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-2212
Practice Address - Country:US
Practice Address - Phone:267-368-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP010214224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA225X00000XOther225X00000X - OCCUPATIONAL THERAPIST