Provider Demographics
NPI:1649423922
Name:KEAN, PAMELA S (OTR)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:KEAN
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 1:211 S POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-1845
Mailing Address - Country:US
Mailing Address - Phone:605-773-7300
Mailing Address - Fax:605-773-7304
Practice Address - Street 1:900 N POPLAR
Practice Address - Street 2:JEFFERSON ELEMENTARY
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-1850
Practice Address - Country:US
Practice Address - Phone:605-773-7320
Practice Address - Fax:605-773-7320
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0068225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics