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NPI Code Detail

MEDICARE: MRS. BETHANY ALICE KEENER M.S., OTR/L

MEDICARE: MRS. BETHANY ALICE KEENER M.S., OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist13484CA

General Provider Information

NPI Number : 1083051619
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETHANY ALICE KEENER M.S., OTR/L
Provider Business Mailing Address
First Line : 2728 PRINCE ST
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2613
Country : US
Telephone Number : 201-819-5569
Fax Number :
Provider Business Practice Location Address
First Line : 2780 26TH AVE
Second Line :
City : OAKLAND
State : CA
Zip : 94601-1911
Country : US
Telephone Number : 510-536-1838
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2013
Last Update Date : 05/22/2013

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