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NPI Code Detail

MEDICARE: BENJAMIN HOUSTON KEELING MSOT

MEDICARE: BENJAMIN HOUSTON KEELING MSOT
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 Therapist
2225XP0200XPediatric Occupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OT007214OTHERGAGEORGIA LICENSE

General Provider Information

NPI Number : 1104395813
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN HOUSTON KEELING MSOT
Provider Business Mailing Address
First Line : 11660 ALPHARETTA HWY STE 200
Second Line :
City : ROSWELL
State : GA
Zip : 30076-3874
Country : US
Telephone Number : 404-436-7416
Fax Number : 770-643-0869
Provider Business Practice Location Address
First Line : 11660 ALPHARETTA HWY STE 200
Second Line :
City : ROSWELL
State : GA
Zip : 30076-3874
Country : US
Telephone Number : 404-436-7416
Fax Number : 770-643-0869
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2018
Last Update Date : 04/03/2026

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Directions to “ BENJAMIN HOUSTON KEELING MSOT” Practice Location

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