Provider Demographics
NPI:1952726531
Name:KEEGAN, TAYLOR
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CYPRESS TRACE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1089
Mailing Address - Country:US
Mailing Address - Phone:603-498-8603
Mailing Address - Fax:
Practice Address - Street 1:501 CYPRESS TRACE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1089
Practice Address - Country:US
Practice Address - Phone:603-498-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist