Individual
MS. KIMBERLY A. KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 661-4666
Mailing address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 661-4666
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056004609
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
STATE LICENSE
056004609
IL
Enumeration date
08/07/2007
Last updated
03/01/2019
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