Provider Demographics
NPI:1427038934
Name:KELLER, RENEE M (OT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:M
Last Name:KELLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:M
Other - Last Name:RUPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:301 1ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4756
Mailing Address - Country:US
Mailing Address - Phone:724-282-4764
Mailing Address - Fax:724-282-6624
Practice Address - Street 1:301 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-4756
Practice Address - Country:US
Practice Address - Phone:724-282-4764
Practice Address - Fax:724-282-6624
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006041L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA063966HBGMedicare PIN