Provider Demographics
NPI:1306980669
Name:KEELEY, KIMBERLY JEAN (ATC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:KEELEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-1022
Mailing Address - Country:US
Mailing Address - Phone:724-991-0693
Mailing Address - Fax:
Practice Address - Street 1:1 MORROW WAY
Practice Address - Street 2:011 MORROW FIELD HOUSE, SLIPPERY ROCK UNIVERSITY
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-1313
Practice Address - Country:US
Practice Address - Phone:724-738-2621
Practice Address - Fax:724-738-4871
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0040772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer