Healthcare Provider Details

I. General information

NPI: 1043252315
Provider Name (Legal Business Name): TRACIE O'KEEFE MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SACO HEALING ARTS CENTER 209 MAIN STREET, SUITE 301
SACO ME
04072
US

IV. Provider business mailing address

18 HIGHLAND ST
BIDDEFORD ME
04005-2106
US

V. Phone/Fax

Practice location:
  • Phone: 207-229-3435
  • Fax:
Mailing address:
  • Phone: 207-229-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT2486
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT2486
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: