MEDICARE: SUSAN D KEITH CFM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225000000X	Orthotic Fitter	CFM02267	NC

General Provider Information

NPI Number	:	1619282217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN D KEITH CFM

Provider Business Mailing Address
First Line	:	1142 SHIPYARD BLVD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-6439
Country	:	US
Telephone Number	:	910-350-0067
Fax Number	:	910-350-0065

Provider Business Practice Location Address
First Line	:	200 JEFFERSON ST
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-3416
Country	:	US
Telephone Number	:	910-640-2939
Fax Number	:	910-640-3938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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Directions to “ SUSAN D KEITH CFM” Practice Location

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