Provider Demographics
NPI:1841935921
Name:KEETON, MADALYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:MADALYNN
Middle Name:
Last Name:KEETON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MADALYNN
Other - Middle Name:KEETON
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 OLD US 501
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27574-7516
Mailing Address - Country:US
Mailing Address - Phone:336-503-2182
Mailing Address - Fax:
Practice Address - Street 1:615 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4629
Practice Address - Country:US
Practice Address - Phone:336-599-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist