Basic Information
| Provider Information | |||||||||
| NPI: | 1316112527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENNINGS-EAKIN | ||||||||
| FirstName: | KEISHA | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2962 COLCHESTER CT | ||||||||
| Address2: | |||||||||
| City: | ABINGDON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210091922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434025490 | ||||||||
| FaxNumber: | 4344206747 | ||||||||
| Practice Location | |||||||||
| Address1: | 658 BOULTON ST | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015818054 | ||||||||
| FaxNumber: | 3015640284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2008 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 06121 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XE0001X | 06121 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification | 225XG0600X | 06121 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | 225XR0403X | 06121 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility | 225X00000X | T00599 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 131611257 | 05 | MD | MEDICAID |