Provider Demographics
NPI:1790728343
Name:KEITH, MARY C (OTR)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:KEITH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 SW 75TH ST APT D32
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7449
Mailing Address - Country:US
Mailing Address - Phone:850-319-6043
Mailing Address - Fax:
Practice Address - Street 1:5333 SW 75TH ST APT D32
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7449
Practice Address - Country:US
Practice Address - Phone:850-319-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99496225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist