Healthcare Provider Details

I. General information

NPI: 1235006990
Provider Name (Legal Business Name): TIMOTHY JOHN O'KEEFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 FALCON CREST CIR
HEBRON KY
41048-9336
US

IV. Provider business mailing address

1888 FALCON CREST CIR
HEBRON KY
41048-9336
US

V. Phone/Fax

Practice location:
  • Phone: 513-368-7258
  • Fax:
Mailing address:
  • Phone: 513-368-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: