Doctor Name: | LECEA A KETZLER |
NPI Number: | 1699888958 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DO |
License Number: | 1885 |
Business Practice Address: | 379 Methodist Rd Westbrook, ME - 04092 |
Business Phone Number: | 2078544638 |
Business Fax Number: | |
Mailing Address: | Po Box 810, WESTBROOK |
State: | ME |
Postal Code: | 040980810 |
Phone Number: | 2078541544 |
Fax Number: | 2078541516 |
NPI Enumeration Date: | 08/17/2006 |
NPI Last Update Date: | 09/24/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | 1885 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |