Provider Demographics
NPI:1619704905
Name:KEESLER, SYDNI
Entity type:Individual
Prefix:
First Name:SYDNI
Middle Name:
Last Name:KEESLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3814
Mailing Address - Country:US
Mailing Address - Phone:814-363-7118
Mailing Address - Fax:
Practice Address - Street 1:1626 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1935
Practice Address - Country:US
Practice Address - Phone:716-375-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63-P131185-01225X00000X
NY029536225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist