Provider Demographics
NPI:1235719733
Name:KEELER, MARILYN LEAH (CFTS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:LEAH
Last Name:KEELER
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3223
Mailing Address - Country:US
Mailing Address - Phone:910-929-6944
Mailing Address - Fax:
Practice Address - Street 1:402 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3223
Practice Address - Country:US
Practice Address - Phone:910-929-6944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter