Healthcare Provider Details

I. General information

NPI: 1003770975
Provider Name (Legal Business Name): MOLLY KELLER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MAIN ST STE 2 #111
PALMYRA PA
17078-9517
US

IV. Provider business mailing address

1200 E MAIN ST STE 2 #111
PALMYRA PA
17078-9517
US

V. Phone/Fax

Practice location:
  • Phone: 717-483-7662
  • Fax: 717-922-6324
Mailing address:
  • Phone: 717-483-7662
  • Fax: 717-922-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL018776
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: