Healthcare Provider Details

I. General information

NPI: 1356555650
Provider Name (Legal Business Name): SARA ELIZABETH KELLER OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17220 N BOSWELL BLVD STE L200
SUN CITY AZ
85373
US

IV. Provider business mailing address

PO BOX 3457
CAREFREE AZ
85377
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-4911
  • Fax: 623-977-4919
Mailing address:
  • Phone: 480-595-2184
  • Fax: 480-595-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: