Provider Demographics
NPI:1376008284
Name:KEENER, KAREN LYNN (LMT, AT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:KEENER
Suffix:
Gender:F
Credentials:LMT, AT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNN
Other - Last Name:MAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, AT
Mailing Address - Street 1:3705 STATE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5957
Mailing Address - Country:US
Mailing Address - Phone:440-997-0014
Mailing Address - Fax:440-998-7032
Practice Address - Street 1:3705 STATE RD STE 102
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5957
Practice Address - Country:US
Practice Address - Phone:440-997-0014
Practice Address - Fax:440-998-7032
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.009680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist