Provider Demographics
NPI:1659774792
Name:KEELER, HEATHER (DPM)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:KEELER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 WILLAMETTE FALLS DR. #111
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068
Mailing Address - Country:US
Mailing Address - Phone:503-657-1900
Mailing Address - Fax:
Practice Address - Street 1:1880 WILLAMETTE FALLS DR STE 111
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4653
Practice Address - Country:US
Practice Address - Phone:503-657-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN763213ES0103X
ORDP182767213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery