Healthcare Provider Details

I. General information

NPI: 1649674367
Provider Name (Legal Business Name): LISA M KEOUGH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BELLA VIDA BLVD. CREATIVE SPEECH SOLUTIONS & THERAPY
ORLANDO FL
32828
US

IV. Provider business mailing address

447 BELLA VIDA BLVD. CREATIVE SPEECH SOLUTIONS & THERAPY
ORLANDO FL
32828
US

V. Phone/Fax

Practice location:
  • Phone: 321-961-3489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: