Healthcare Provider Details

I. General information

NPI: 1821074675
Provider Name (Legal Business Name): KATHLEEN ALICE O'KEEFE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 ANDOVER ST SUITE 209
NORTH ANDOVER MA
01845-5044
US

IV. Provider business mailing address

451 ANDOVER ST SUITE 209
NORTH ANDOVER MA
01845-5044
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-7623
  • Fax: 978-683-9911
Mailing address:
  • Phone: 978-686-7623
  • Fax: 978-683-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0304
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2207
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: