Provider Demographics
NPI:1659754406
Name:KELLAR, WENDI
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:KELLAR
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 1:16420 E ELK RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7638
Mailing Address - Country:US
Mailing Address - Phone:907-315-3491
Mailing Address - Fax:
Practice Address - Street 1:1830 E PARKS HWY STE A120
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7380
Practice Address - Country:US
Practice Address - Phone:907-373-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist