Provider Demographics
NPI:1710664453
Name:KEANE, KIMBERLY BETH
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BETH
Last Name:KEANE
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 1:3104 W 118TH ST
Mailing Address - Street 2:
Mailing Address - City:MERRIONETTE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60803-3002
Mailing Address - Country:US
Mailing Address - Phone:708-712-8902
Mailing Address - Fax:
Practice Address - Street 1:3104 W 118TH ST
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-3002
Practice Address - Country:US
Practice Address - Phone:708-712-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist