Provider Demographics
NPI:1174063945
Name:KEULER, DIANE CAROL
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CAROL
Last Name:KEULER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW FREEDOM
Mailing Address - State:PA
Mailing Address - Zip Code:17349-9253
Mailing Address - Country:US
Mailing Address - Phone:717-880-6864
Mailing Address - Fax:
Practice Address - Street 1:2542 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-9253
Practice Address - Country:US
Practice Address - Phone:717-880-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician