Healthcare Provider Details

I. General information

NPI: 1497083695
Provider Name (Legal Business Name): KEITH THOMAS PARKER MOT, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2009
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 VENUS AVE
HARRISBURG PA
17112-9122
US

IV. Provider business mailing address

1926 MARKET ST
CAMP HILL PA
17011-4701
US

V. Phone/Fax

Practice location:
  • Phone: 302-690-6993
  • Fax:
Mailing address:
  • Phone: 717-506-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010937
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: