MEDICARE: MS. TONYA KAYE KELLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist	1954	KY

General Provider Information

NPI Number	:	1447471354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONYA KAYE KELLER

Provider Business Mailing Address
First Line	:	1045 HAMILTON RD
Second Line	:
City	:	PARK HILLS
State	:	KY
Zip	:	41011-2036
Country	:	US
Telephone Number	:	859-801-6317
Fax Number	:	859-431-0248

Provider Business Practice Location Address
First Line	:	1045 HAMILTON RD
Second Line	:
City	:	PARK HILLS
State	:	KY
Zip	:	41011-2036
Country	:	US
Telephone Number	:	859-801-6317
Fax Number	:	859-431-0248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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