Healthcare Provider Details

I. General information

NPI: 1124772025
Provider Name (Legal Business Name): MADELYNN KECKEIS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WINCHESTER BLVD
CANAL WINCHESTER OH
43110-2068
US

IV. Provider business mailing address

6355 WINCHESTER BLVD
CANAL WINCHESTER OH
43110-2068
US

V. Phone/Fax

Practice location:
  • Phone: 740-759-7099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: