Provider Demographics
NPI:1356468433
Name:KELLER, SARAH MARIE (ATCL, LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIE
Last Name:KELLER
Suffix:
Gender:F
Credentials:ATCL, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27700 EUCLID AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3514
Mailing Address - Country:US
Mailing Address - Phone:216-289-2632
Mailing Address - Fax:216-289-2654
Practice Address - Street 1:27700 EUCLID AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3514
Practice Address - Country:US
Practice Address - Phone:216-289-2632
Practice Address - Fax:216-289-2654
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT- 26682255A2300X
OH33.010120225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist