MEDICARE: MRS. DEONZA IRENE KEETON 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
1	225X00000X	Occupational Therapist	133204	KY

General Provider Information

NPI Number	:	1285258400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEONZA IRENE KEETON OTR/L

Provider Business Mailing Address
First Line	:	204 CARLA CT
Second Line	:
City	:	DRY RIDGE
State	:	KY
Zip	:	41035-9000
Country	:	US
Telephone Number	:	859-428-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FARRELL DR
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41011-3785
Country	:	US
Telephone Number	:	859-341-0777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	06/03/2020

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