Healthcare Provider Details

I. General information

NPI: 1457819849
Provider Name (Legal Business Name): MATTHEW O'KEEFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6959 GOLDEN RING RD
ROSEDALE MD
21237-3033
US

IV. Provider business mailing address

1826 FALLSTAFF CT
ELDERSBURG MD
21784-6274
US

V. Phone/Fax

Practice location:
  • Phone: 386-689-2112
  • Fax: 386-767-4319
Mailing address:
  • Phone: 443-280-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: