Provider Demographics
NPI:1770674012
Name:KEEN, MONICA DELEAH (MS, ORT/L)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:DELEAH
Last Name:KEEN
Suffix:
Gender:F
Credentials:MS, ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GALSWORTHY DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7025
Mailing Address - Country:US
Mailing Address - Phone:843-345-6402
Mailing Address - Fax:843-569-0550
Practice Address - Street 1:105 GALSWORTHY DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7025
Practice Address - Country:US
Practice Address - Phone:843-345-6402
Practice Address - Fax:843-569-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0074Medicaid