Provider Demographics
NPI:1952020828
Name:KEITSOCK, TAMMI RENEE
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:RENEE
Last Name:KEITSOCK
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 1:118 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1304
Mailing Address - Country:US
Mailing Address - Phone:215-534-6501
Mailing Address - Fax:
Practice Address - Street 1:118 S 5TH ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-1304
Practice Address - Country:US
Practice Address - Phone:215-534-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports