Individual
JESSICA B KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1912 MEMORIAL AVE, LYNCHBURG, VA 24501-1708
(434) 845-8765
Mailing address
1912 MEMORIAL AVE, LYNCHBURG, VA 24501-1708
(434) 845-8765
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004978757
—
VA
01
—
192596
ANTHEM BC/BS
VA
Enumeration date
06/13/2006
Last updated
10/06/2008
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