Healthcare Provider Details

I. General information

NPI: 1629296710
Provider Name (Legal Business Name): MARY CATHERINE SAVAGE KEEFE AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4511
US

IV. Provider business mailing address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4511
US

V. Phone/Fax

Practice location:
  • Phone: 703-317-1480
  • Fax:
Mailing address:
  • Phone: 703-317-1480
  • Fax: 703-317-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101001320
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001097
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: