| Doctor Name: | MARTHA JANE KELLER |
| NPI Number: | 1194811851 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, LSW |
| License Number: | S-0002135 |
| Business Practice Address: | 2458 Stetzer Rd Bucyrus, OH - 44820 |
| Business Phone Number: | 4195622000 |
| Business Fax Number: | 4195621296 |
| Mailing Address: | Po Box 756, BUCYRUS |
| State: | OH |
| Postal Code: | 44820 |
| Phone Number: | 4195622000 |
| Fax Number: | 4195621296 |
| NPI Enumeration Date: | 10/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | S-0002135 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |