Provider Demographics
NPI:1659874022
Name:KEEL, JILL MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MICHELLE
Last Name:KEEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 BERRYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6831
Mailing Address - Country:US
Mailing Address - Phone:405-359-9143
Mailing Address - Fax:
Practice Address - Street 1:13501 N BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6242
Practice Address - Country:US
Practice Address - Phone:405-246-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist