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General NPI Number Information
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NPI Number | 1013483098
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Entity Type | Organization
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Legal Business Name | JM KEANE INC
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 2528 DON PEDRO NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-3063
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Country | US
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Telephone | 505-550-4096
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Fax | 505-212-0155
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Provider Business Mailing Address
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Address Line | 2528 DON PEDRO NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-3063
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Country | US
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Telephone | 505-550-4096
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Fax | 505-212-0155
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Authorized Official
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Title or Position | OWNER
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Name | JOANNE MOIRA KEANE
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Credential | MOTR/L
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Telephone | 505-550-4096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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