Provider Demographics
NPI:1831133255
Name:O'KEEFE, DAWN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:O'KEEFE
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:PO BOX 8419
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-8087
Mailing Address - Country:US
Mailing Address - Phone:228-388-5714
Mailing Address - Fax:228-388-0017
Practice Address - Street 1:498 TUSCAN AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-5461
Practice Address - Country:US
Practice Address - Phone:601-543-0221
Practice Address - Fax:601-543-0201
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015385Medicaid
MS1033218524OtherGROUP NPI
MS09015077Medicaid
MSC02726OtherGROUP MEDICARE PTAN
MS512I650070Medicare UPIN