Provider Demographics
NPI:1609049782
Name:KEANE, PATRICIA (OTD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-340-0329
Mailing Address - Fax:
Practice Address - Street 1:2525 N ANKENY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4714
Practice Address - Country:US
Practice Address - Phone:515-965-4594
Practice Address - Fax:515-965-4448
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06079225X00000X
IA001994225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist