Healthcare Provider Details

I. General information

NPI: 1386557577
Provider Name (Legal Business Name): AILEYZJIA KEATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 POST OFFICE PARK UNIT 8
WILBRAHAM MA
01095-7701
US

IV. Provider business mailing address

59 NEW LUDLOW RD APT 10D
CHICOPEE MA
01020-4046
US

V. Phone/Fax

Practice location:
  • Phone: 413-237-2030
  • Fax:
Mailing address:
  • Phone: 413-433-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: