Provider Demographics
NPI:1578119145
Name:THOMAS, KEIGHAN
Entity Type:Individual
Prefix:
First Name:KEIGHAN
Middle Name:
Last Name:THOMAS
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 1:2298 S CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45325-9282
Mailing Address - Country:US
Mailing Address - Phone:937-620-8401
Mailing Address - Fax:
Practice Address - Street 1:2298 S CLAYTON RD
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45325-9282
Practice Address - Country:US
Practice Address - Phone:937-620-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator