Provider Demographics
NPI:1811429509
Name:KELDER, KARI TYLER
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:TYLER
Last Name:KELDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CLEARWATER CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4994
Mailing Address - Country:US
Mailing Address - Phone:510-909-3376
Mailing Address - Fax:
Practice Address - Street 1:1500 S UNIVERSITY PARKS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1731
Practice Address - Country:US
Practice Address - Phone:510-909-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer