Provider Demographics
NPI:1598524001
Name:MCLAUGHLIN, KEELY ROSE
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:ROSE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 RIVERSIDE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3141
Mailing Address - Country:US
Mailing Address - Phone:773-892-6597
Mailing Address - Fax:
Practice Address - Street 1:113 CUMBERLAND AVE STE 110
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-3339
Practice Address - Country:US
Practice Address - Phone:615-596-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist