Provider Demographics
NPI:1649521006
Name:KEEGAN, JAMIE L
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:L
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-3204
Mailing Address - Country:US
Mailing Address - Phone:617-571-4030
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTH ST STE B
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2205
Practice Address - Country:US
Practice Address - Phone:508-298-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency