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NPI Code Detail

MEDICARE: MRS. JODY KEENUM OTR/L

MEDICARE: MRS. JODY KEENUM OTR/L
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
1225X00000XOccupational Therapist0092AL

General Provider Information

NPI Number : 1679817100
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JODY KEENUM OTR/L
Provider Business Mailing Address
First Line : 2612 SHERWOOD DR SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-6733
Country : US
Telephone Number : 256-606-6426
Fax Number :
Provider Business Practice Location Address
First Line : 1350 14TH AVE SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-4364
Country : US
Telephone Number : 256-355-6911
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2012
Last Update Date : 11/21/2012

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