Individual
MRS. MICHELLE LEE KEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
712 FOXWOOD DR, JACKSONVILLE, AR 72076-2642
(501) 985-0162
Mailing address
712 FOXWOOD DR, JACKSONVILLE, AR 72076-2642
(501) 985-0162
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTR1129
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5W836
AR BCBS
AR
Enumeration date
05/04/2007
Last updated
07/09/2007
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