Provider Demographics
NPI:1235748500
Name:KEILI, RUTH J
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:J
Last Name:KEILI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3562 OLD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5521
Mailing Address - Country:US
Mailing Address - Phone:757-812-3776
Mailing Address - Fax:
Practice Address - Street 1:3562 OLD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5521
Practice Address - Country:US
Practice Address - Phone:757-812-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty