MEDICARE: EMILIE KEAN

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	19780	FL

General Provider Information

NPI Number	:	1528798071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIE KEAN

Provider Business Mailing Address
First Line	:	8150 NW 51ST ST
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33351-5044
Country	:	US
Telephone Number	:	954-235-9971
Fax Number	:

Provider Business Practice Location Address
First Line	:	7595 SW 33RD ST
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7708
Country	:	US
Telephone Number	:	800-541-6682
Fax Number	:

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

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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Directions to “ EMILIE KEAN ” Practice Location

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