Provider Demographics
NPI:1033267760
Name:KELLER, OWEN J (ATC)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:J
Last Name:KELLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-6000
Mailing Address - Country:US
Mailing Address - Phone:419-772-3135
Mailing Address - Fax:419-772-2470
Practice Address - Street 1:525 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-6000
Practice Address - Country:US
Practice Address - Phone:419-772-3135
Practice Address - Fax:419-772-2470
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-0001882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer