Individual
LYDIA KEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27 WHIPPOORWILL LN, LONGVIEW, WA 98632-0703
(368) 431-3896
Mailing address
27 WHIPPOORWILL LANE, LONGVIEW, WA 98632
(368) 431-3896
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT00001319
WA
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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