Doctor Name: | MR. PHELO JOSEPH KELLER |
NPI Number: | 1366505612 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OTSC |
License Number: | NBCOT981110 |
Business Practice Address: | 1300 Lakewood Dr Suite D Morgan City, LA - 70380 |
Business Phone Number: | 9853847900 |
Business Fax Number: | 9853848049 |
Mailing Address: | Po Box 2375, MORGAN CITY |
State: | LA |
Postal Code: | 70381 |
Phone Number: | 9853847900 |
Fax Number: | 9853848049 |
NPI Enumeration Date: | 12/18/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246Z00000X |
License Number: | NBCOT981110 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | |
Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |