Provider Demographics
NPI:1114166741
Name:KEAYS, ERICA A (LMT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:A
Last Name:KEAYS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 DIX AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3290
Mailing Address - Country:US
Mailing Address - Phone:518-879-9269
Mailing Address - Fax:
Practice Address - Street 1:217 DIX AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3290
Practice Address - Country:US
Practice Address - Phone:518-879-9269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017421-0247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other