Provider Demographics
NPI:1174396824
Name:O'KEEFE, CONNOR PATRICK
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:PATRICK
Last Name:O'KEEFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 OREGON ST UNIT 5
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-7137
Mailing Address - Country:US
Mailing Address - Phone:920-527-1642
Mailing Address - Fax:
Practice Address - Street 1:W235N6350 HICKORY DR
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-1152
Practice Address - Country:US
Practice Address - Phone:262-932-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8432-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist