Provider Demographics
NPI:1508900192
Name:O'KEEFE, REBECCA SUSAN (OTR)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUSAN
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3378 COUNTY ROAD F
Mailing Address - Street 2:
Mailing Address - City:OMRO
Mailing Address - State:WI
Mailing Address - Zip Code:54963-9408
Mailing Address - Country:US
Mailing Address - Phone:920-685-0942
Mailing Address - Fax:
Practice Address - Street 1:1800 APPLETON RD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3727
Practice Address - Country:US
Practice Address - Phone:920-968-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3606026225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3606026OtherTHERAPY LICENSE
WI40775200Medicaid