MEDICARE: MRS. JENNIFER KEELE LMT

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	225700000X	Massage Therapist	MT-29277	AZ

General Provider Information

NPI Number	:	1972483329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER KEELE LMT

Provider Business Mailing Address
First Line	:	1640 ANITA CT
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86404-1224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1695 MESQUITE AVE STE 114
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5687
Country	:	US
Telephone Number	:	928-453-6808
Fax Number	:

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

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	09/05/2025

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