Provider Demographics
NPI:1164965950
Name:KEILES, LAURA (ND, CTN, LMBT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KEILES
Suffix:
Gender:F
Credentials:ND, CTN, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 US HIGHWAY 22 STE 1105
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-4405
Mailing Address - Country:US
Mailing Address - Phone:908-396-7788
Mailing Address - Fax:
Practice Address - Street 1:3322 US HIGHWAY 22 STE 1105
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-4405
Practice Address - Country:US
Practice Address - Phone:908-396-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 171400000X, 174H00000X, 175L00000X, 175F00000X
NJ18KT01047800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No175L00000XOther Service ProvidersHomeopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist