Provider Demographics
NPI:1598480030
Name:PARKER, KEANA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KEANA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KEANA
Other - Middle Name:
Other - Last Name:DIGIACOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30953 BAILEYS LN
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-5027
Mailing Address - Country:US
Mailing Address - Phone:772-538-0937
Mailing Address - Fax:
Practice Address - Street 1:5800 OVERSEAS HWY STE 43
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2744
Practice Address - Country:US
Practice Address - Phone:772-538-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT23581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist