Provider Demographics
NPI:1043252315
Name:O'KEEFE, TRACIE (MT)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2106
Mailing Address - Country:US
Mailing Address - Phone:207-229-3435
Mailing Address - Fax:
Practice Address - Street 1:SACO HEALING ARTS CENTER
Practice Address - Street 2:209 MAIN STREET, SUITE 301
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072
Practice Address - Country:US
Practice Address - Phone:207-229-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2486174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME079097OtherBLUE CROSS BLUE SHIELD