Basic Information
| Provider Information | |||||||||
| NPI: | 1992952691 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEAN | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4551 SUNNYSIDE RD SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973023928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035405326 | ||||||||
| FaxNumber: | 5035668595 | ||||||||
| Practice Location | |||||||||
| Address1: | 4515 SUNNYSIDE RD SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973023928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035405326 | ||||||||
| FaxNumber: | 5035668595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2008 | ||||||||
| LastUpdateDate: | 08/25/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 456459 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.