Provider Demographics
NPI:1437373206
Name:COON, KEITH P (OTRL)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:P
Last Name:COON
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E 400 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1958
Mailing Address - Country:US
Mailing Address - Phone:801-489-5669
Mailing Address - Fax:801-489-5783
Practice Address - Street 1:1000 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1600
Practice Address - Country:US
Practice Address - Phone:801-465-7070
Practice Address - Fax:801-465-7001
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4832156-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist