Provider Demographics
NPI:1346601275
Name:KEITH, AMANDA MAY (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAY
Last Name:KEITH
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 1:128 MAPLE LANE NE APT. C
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9036
Mailing Address - Country:US
Mailing Address - Phone:740-877-8998
Mailing Address - Fax:
Practice Address - Street 1:128 MAPLE LN NE APT C
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9036
Practice Address - Country:US
Practice Address - Phone:740-877-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-20
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022382225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist