Provider Demographics
NPI:1730346610
Name:KEOGH-DODGE, CHERIE CASING (MA, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:CASING
Last Name:KEOGH-DODGE
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:CASING
Other - Last Name:KEOGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, OTR/L
Mailing Address - Street 1:2609 GLENN HENDREN DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068
Mailing Address - Country:US
Mailing Address - Phone:816-407-4555
Mailing Address - Fax:816-781-6973
Practice Address - Street 1:398 BLUE JAY DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1977
Practice Address - Country:US
Practice Address - Phone:816-407-2315
Practice Address - Fax:816-407-1555
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5067-026225X00000X
CA9759225XH1200X
FL13354225XH1200X
MO2014034968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI860400014OtherMEDICARE