Provider Demographics
NPI:1740776178
Name:SCHMIDT, KEENAN LAURA
Entity Type:Individual
Prefix:
First Name:KEENAN
Middle Name:LAURA
Last Name:SCHMIDT
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 1:670 KING PARK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6257
Mailing Address - Country:US
Mailing Address - Phone:406-655-4940
Mailing Address - Fax:
Practice Address - Street 1:670 KING PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6257
Practice Address - Country:US
Practice Address - Phone:406-655-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist