Healthcare Provider Details

I. General information

NPI: 1679728885
Provider Name (Legal Business Name): DENISE M KEEGAN OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NORTH GRAND AVE
NATIONAL PARK NJ
08063
US

IV. Provider business mailing address

300 GRAND AVE
NATIONAL PARK NJ
08063-1029
US

V. Phone/Fax

Practice location:
  • Phone: 609-238-5344
  • Fax:
Mailing address:
  • Phone: 609-238-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number015305-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: