Healthcare Provider Details

I. General information

NPI: 1689046591
Provider Name (Legal Business Name): MRS. MEGAN KEOHANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 BOCA WOODS LN
BOCA RATON FL
33428-1828
US

IV. Provider business mailing address

10310 BOCA WOODS LN
BOCA RATON FL
33428-1828
US

V. Phone/Fax

Practice location:
  • Phone: 718-433-6222
  • Fax:
Mailing address:
  • Phone: 718-433-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: