Provider Demographics
NPI:1114693868
Name:KEENER, THOMAS ALAN
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:KEENER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 REIMER RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8427
Mailing Address - Country:US
Mailing Address - Phone:133-035-0131
Mailing Address - Fax:
Practice Address - Street 1:311 REIMER RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8427
Practice Address - Country:US
Practice Address - Phone:330-350-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care