MEDICARE: TAKARA KEELE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1841907110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKARA KEELE

Provider Business Mailing Address
First Line	:	224 W 35TH ST STE 500
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2538
Country	:	US
Telephone Number	:	833-646-3222
Fax Number	:

Provider Business Practice Location Address
First Line	:	8507 CULEBRA RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4810
Country	:	US
Telephone Number	:	833-646-3222
Fax Number	:

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

Provider Enumeration Date	:	11/04/2022
Last Update Date	:	11/04/2022

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Directions to “ TAKARA KEELE ” Practice Location

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