Healthcare Provider Details

I. General information

NPI: 1891975819
Provider Name (Legal Business Name): NICHOLAS ARTHUR KEULER M.S., L.A.T., A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 EATON AVE
HAMILTON OH
45013-1407
US

IV. Provider business mailing address

1390 EATON AVE
HAMILTON OH
45013-1407
US

V. Phone/Fax

Practice location:
  • Phone: 513-863-2215
  • Fax:
Mailing address:
  • Phone: 513-863-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.002715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: