Healthcare Provider Details

I. General information

NPI: 1295480531
Provider Name (Legal Business Name): CHRISTINE KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 NOBLE RD
CLEVELAND OH
44112-1725
US

IV. Provider business mailing address

8558 EAGLE RD
KIRTLAND OH
44094-8613
US

V. Phone/Fax

Practice location:
  • Phone: 216-268-2400
  • Fax:
Mailing address:
  • Phone: 216-777-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: