Provider Demographics
NPI:1639239445
Name:KEY CORPORATION
Entity Type:Organization
Organization Name:KEY CORPORATION
Other - Org Name:PROFESSIONAL REHABILITATION CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-784-7828
Mailing Address - Street 1:1394 JACKSON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4630
Mailing Address - Country:US
Mailing Address - Phone:651-603-8774
Mailing Address - Fax:651-603-9009
Practice Address - Street 1:1394 JACKSON ST STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-4630
Practice Address - Country:US
Practice Address - Phone:651-603-8774
Practice Address - Fax:651-603-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN756104100Medicaid
MN876555300Medicaid
MN6G530PROtherBLUE CROSS BLUE SHIELD
MN103288OtherUCARE