Provider Demographics
NPI:1740679497
Name:KELLER, DENALLIA (COTA/L)
Entity type:Individual
Prefix:
First Name:DENALLIA
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:DENALLIA
Other - Middle Name:
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1008 S CLAIRBORNE RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2138
Mailing Address - Country:US
Mailing Address - Phone:913-449-8526
Mailing Address - Fax:
Practice Address - Street 1:1223 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006-4011
Practice Address - Country:US
Practice Address - Phone:785-594-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00470224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant