Provider Demographics
NPI:1669695979
Name:KEPPEN, DENA LYNN (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:DENA
Middle Name:LYNN
Last Name:KEPPEN
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13351 CRYSTAL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-9636
Mailing Address - Country:US
Mailing Address - Phone:541-892-2539
Mailing Address - Fax:
Practice Address - Street 1:13351 CRYSTAL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-9636
Practice Address - Country:US
Practice Address - Phone:541-892-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20666225100000X
OR2063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR182019Medicaid
OR182019Medicaid