MEDICARE: MR. MICHAEL KEITH KEENE II LICENSED ORTHOTIST,

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	174400000X	Specialist	45OR00006900	NJ

General Provider Information

NPI Number	:	1760523112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL KEITH KEENE II LICENSED ORTHOTIST,

Provider Business Mailing Address
First Line	:	6367 WOODBINE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2523
Country	:	US
Telephone Number	:	610-724-3561
Fax Number	:	215-722-0752

Provider Business Practice Location Address
First Line	:	336 LONEY ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19111-2236
Country	:	US
Telephone Number	:	215-722-0751
Fax Number	:

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	04/22/2014

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