Provider Demographics
NPI:1760580146
Name:KELLER, MAUREEN A (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:A
Last Name:KELLER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 MUNROE FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3674
Mailing Address - Country:US
Mailing Address - Phone:330-926-0322
Mailing Address - Fax:
Practice Address - Street 1:5700 LOMBARDO CTR STE 205
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-6962
Practice Address - Country:US
Practice Address - Phone:180-098-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00629224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant