Individual
KATHLEEN JOAN KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
15352 W HEARN RD, SURPRISE, AZ 85379-7067
(623) 332-7196
Mailing address
15352 W HEARN RD, SURPRISE, AZ 85379-7067
(623) 332-7196
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5216
AZ
Other
Enumeration date
09/28/2012
Last updated
09/28/2012
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