Individual
KEELEY BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QHMA
Contact information
Practice address
1741 AUSTIN ST, KLAMATH FALLS, OR 97603
(541) 851-6156
Mailing address
1741 AUSTIN ST, KLAMATH FALLS, OR 97603
(541) 851-6156
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
10212642
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063070779
—
OR
Enumeration date
02/22/2021
Last updated
03/17/2021
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