Provider Demographics
NPI:1073877015
Name:KEEFE, TINA LEE (MS-SLP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:LEE
Last Name:KEEFE
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 MARYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904-3000
Mailing Address - Country:US
Mailing Address - Phone:607-738-7888
Mailing Address - Fax:
Practice Address - Street 1:1504 MARYWOOD DR
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-3000
Practice Address - Country:US
Practice Address - Phone:607-738-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist