Healthcare Provider Details

I. General information

NPI: 1710708664
Provider Name (Legal Business Name): KEAGAN CARPENTER OTD, OTR/L, BCPR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEAGAN RICHARD

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

7092 HARR AVE BLDG 6492
FORT CARSON CO
80902-2190
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-5218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0008731
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: