Provider Demographics
NPI:1447437207
Name:KELLER, WENDY L (OTR/L)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:L
Last Name:KELLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LEIGH
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MCM, OTR/L
Mailing Address - Street 1:125 S SIERRA MADRE BLVD UNIT 210
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4140
Mailing Address - Country:US
Mailing Address - Phone:661-714-1455
Mailing Address - Fax:818-244-4729
Practice Address - Street 1:125 S SIERRA MADRE BLVD UNIT 210
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4140
Practice Address - Country:US
Practice Address - Phone:661-714-1455
Practice Address - Fax:626-395-7879
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10496225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist