Provider Demographics
NPI:1073380945
Name:KEELER, ASA
Entity Type:Individual
Prefix:
First Name:ASA
Middle Name:
Last Name:KEELER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 TURTLE COVE LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2318
Mailing Address - Country:US
Mailing Address - Phone:772-569-5699
Mailing Address - Fax:
Practice Address - Street 1:706 TURTLE COVE LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2318
Practice Address - Country:US
Practice Address - Phone:772-569-5699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician