Healthcare Provider Details

I. General information

NPI: 1225620909
Provider Name (Legal Business Name): MOLLY O'KEEFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3138 KIMBALL AVE
WATERLOO IA
50702-5253
US

IV. Provider business mailing address

2401 4TH ST SW STE B
WAVERLY IA
50677-4329
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-4360
  • Fax:
Mailing address:
  • Phone: 319-774-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number120526
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: