Provider Demographics
NPI:1760724991
Name:KELLER, MARION (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:
Last Name:KELLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2514
Mailing Address - Country:US
Mailing Address - Phone:803-931-8166
Mailing Address - Fax:803-931-8183
Practice Address - Street 1:1308 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2514
Practice Address - Country:US
Practice Address - Phone:803-931-8166
Practice Address - Fax:803-931-8183
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1982225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist