Healthcare Provider Details

I. General information

NPI: 1669998225
Provider Name (Legal Business Name): MICHELLE RENEE KEFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 YUCCA DR
FLOWER MOUND TX
75028-2755
US

IV. Provider business mailing address

3525 PREAKNESS DR
FLOWER MOUND TX
75028-3934
US

V. Phone/Fax

Practice location:
  • Phone: 972-874-9400
  • Fax:
Mailing address:
  • Phone: 281-620-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number118136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: