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General NPI Number Information
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NPI Number | 1538435516
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Entity Type | Organization
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Legal Business Name | LAURA KEELEY
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 620 WATER ST
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City | CHARDON
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State | OH
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Zip | 44024-1149
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Country | US
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Telephone | 440-285-9378
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Fax |
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Provider Business Mailing Address
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Address Line | 2532 PHALANX MILLS HERNER RD
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City | SOUTHINGTON
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State | OH
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Zip | 44470-9515
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Country | US
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Telephone | 330-898-6803
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | LAURA ANN KEELEY
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Credential |
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Telephone | 330-898-6803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 08401
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License Number State | OH
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