Individual
FELICIA KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5515 GLEN LAKES DR, DALLAS, TX 75231-4309
(417) 312-2599
Mailing address
2110 N PEAK ST APT 2316, DALLAS, TX 75204-3684
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211685
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211685
—
TX
Enumeration date
10/26/2018
Last updated
10/26/2018
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