Provider Demographics
NPI:1912031246
Name:KELLER, BRONWYN ANN (MS, OTRL)
Entity Type:Individual
Prefix:MS
First Name:BRONWYN
Middle Name:ANN
Last Name:KELLER
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9556
Mailing Address - Country:US
Mailing Address - Phone:717-741-9416
Mailing Address - Fax:
Practice Address - Street 1:385 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9556
Practice Address - Country:US
Practice Address - Phone:717-741-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003504L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist