Provider Demographics
NPI:1740620806
Name:MCFARLANE, KEITH MICHAEL (ATC, PTA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:MICHAEL
Last Name:MCFARLANE
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SPRAY DR
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1325
Mailing Address - Country:US
Mailing Address - Phone:330-338-5000
Mailing Address - Fax:
Practice Address - Street 1:130 SPRAY DR
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1325
Practice Address - Country:US
Practice Address - Phone:330-338-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer