Individual
DENISE A KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2640
Mailing address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1495-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41037900
—
WI
Enumeration date
05/07/2008
Last updated
05/07/2008
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