Provider Demographics
NPI:1730132838
Name:KEPPLEY, DALE L
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:L
Last Name:KEPPLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 STILLVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2146
Mailing Address - Country:US
Mailing Address - Phone:813-684-1601
Mailing Address - Fax:
Practice Address - Street 1:727 STILLVIEW CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2146
Practice Address - Country:US
Practice Address - Phone:813-684-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688018598OtherMED WAIVER PROVIDER #