Individual
MADELINE MCKEEGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4161 TAMIAMI TRL, SUITE 704, PORT CHARLOTTE, FL 33952-9204
(941) 625-1110
(941) 625-0552
Mailing address
4161 TAMIAMI TRL, SUITE 704, PORT CHARLOTTE, FL 33952-9204
(941) 625-1110
(941) 625-0552
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA 23377
FL
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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