MEDICARE: VICTORIA KELLER M.A.

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1992049274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA KELLER M.A.

Provider Business Mailing Address
First Line	:	1026 CONTRAVEST LN
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6343
Country	:	US
Telephone Number	:	407-754-6312
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 W COLONIAL DR
Second Line	:	SUITES 25 & 26
City	:	ORLANDO
State	:	FL
Zip	:	32804-7139
Country	:	US
Telephone Number	:	407-650-5977
Fax Number	:

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

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	11/27/2012

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