Provider Demographics
NPI:1326126327
Name:KELLER, VERNON SCOTT (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:SCOTT
Last Name:KELLER
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 CANDLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-9351
Mailing Address - Country:US
Mailing Address - Phone:812-299-0284
Mailing Address - Fax:
Practice Address - Street 1:5500 WABASH AVE # 41
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-3920
Practice Address - Country:US
Practice Address - Phone:812-877-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000599A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer