Provider Demographics
NPI:1205632478
Name:OKEEFE, JOHN J (LAT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:OKEEFE
Suffix:
Gender:
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 BANKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-6961
Mailing Address - Country:US
Mailing Address - Phone:910-257-7306
Mailing Address - Fax:
Practice Address - Street 1:2301 FORT BRAGG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7035
Practice Address - Country:US
Practice Address - Phone:910-484-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-21612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer