Provider Demographics
NPI:1437488566
Name:KEANE, ERIN (OTR/L,SWC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:OTR/L,SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 SCENICPARK ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1746
Mailing Address - Country:US
Mailing Address - Phone:818-929-2202
Mailing Address - Fax:805-492-3346
Practice Address - Street 1:2234 SCENICPARK ST
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-1746
Practice Address - Country:US
Practice Address - Phone:818-929-2202
Practice Address - Fax:805-492-3346
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-20
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5629225X00000X, 225XF0002X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing