Provider Demographics
NPI:1871219295
Name:KEYSTONE THERAPY
Entity type:Organization
Organization Name:KEYSTONE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BANKSTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:870-941-3644
Mailing Address - Street 1:3000 GRANT 52
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-8114
Mailing Address - Country:US
Mailing Address - Phone:870-941-3644
Mailing Address - Fax:
Practice Address - Street 1:3000 GRANT 52
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-8114
Practice Address - Country:US
Practice Address - Phone:870-941-3644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty