Provider Demographics
NPI:1073972758
Name:LOVELL, KEATON
Entity Type:Individual
Prefix:
First Name:KEATON
Middle Name:
Last Name:LOVELL
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 1:209 NE 5TH
Mailing Address - Street 2:
Mailing Address - City:MCCURTAIN
Mailing Address - State:OK
Mailing Address - Zip Code:74944-3373
Mailing Address - Country:US
Mailing Address - Phone:918-348-5537
Mailing Address - Fax:
Practice Address - Street 1:100 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2602
Practice Address - Country:US
Practice Address - Phone:918-348-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist