Provider Demographics
NPI:1740435320
Name:KECK, KAREN L (COTA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:KECK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 FERN AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4971
Mailing Address - Country:US
Mailing Address - Phone:318-675-0707
Mailing Address - Fax:
Practice Address - Street 1:7330 FERN AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:SHREVPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:817-480-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206654224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant