Provider Demographics
NPI:1245627413
Name:KEITH, BREE (MS, ATC, CES)
Entity type:Individual
Prefix:
First Name:BREE
Middle Name:
Last Name:KEITH
Suffix:
Gender:F
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:BREE
Other - Middle Name:
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 PIN OAK CV
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 HICKORY WOOD AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-6023
Practice Address - Country:US
Practice Address - Phone:501-732-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR540352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer