Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 9128 | SC |
NPI | 1013679414 |
---|---|
Provider Name | Dr. Caitlin Mary Keller |
First Address | Charleston, SC 29414-8126 |
Second Address | Charleston, SC 29401-1164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2021 |
Last Update Date | 13/10/2021 |