Healthcare Provider Details

I. General information

NPI: 1306767736
Provider Name (Legal Business Name): LAUREL TREE LACTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BROOKMEADE CT
TROY OH
45373
US

IV. Provider business mailing address

1841 W MAIN ST # 178
TROY OH
45373-2303
US

V. Phone/Fax

Practice location:
  • Phone: 937-216-9455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA KELLER
Title or Position: OWNER
Credential: BSN,RN,IBCLC
Phone: 937-216-9455