Provider Demographics
NPI:1760523112
Name:KEENE, MICHAEL KEITH II (LICENSED ORTHOTIST,)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEITH
Last Name:KEENE
Suffix:II
Gender:M
Credentials:LICENSED ORTHOTIST,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6367 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2523
Mailing Address - Country:US
Mailing Address - Phone:610-724-3561
Mailing Address - Fax:215-722-0752
Practice Address - Street 1:336 LONEY ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111-2236
Practice Address - Country:US
Practice Address - Phone:215-722-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45OR00006900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist