Provider Demographics
NPI:1154859098
Name:KEELEY, JODY ELAINE
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:ELAINE
Last Name:KEELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 BOLTZ LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DRY RIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:41035-7820
Mailing Address - Country:US
Mailing Address - Phone:859-653-7410
Mailing Address - Fax:
Practice Address - Street 1:242 BOLTZ LAKE RD
Practice Address - Street 2:
Practice Address - City:DRY RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41035-7820
Practice Address - Country:US
Practice Address - Phone:859-653-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist