Basic Information
| Provider Information | |||||||||
| NPI: | 1578136891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEISER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38750 SPIEDEL TOWN RD | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437199621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402137238 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 HALLORAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | ST.CLAIRSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439504395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402965952 | ||||||||
| FaxNumber: | 7402965952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2021 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | OH | Y |
No ID Information.