=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245196302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL MAX KELLER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2026
-----------------------------------------------------
Last Update Date | 01/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 FERRY ST
-----------------------------------------------------
City | SOUTH GRAFTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01560-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-437-2461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 FERRY ST
-----------------------------------------------------
City | SOUTH GRAFTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01560-1325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------