Provider Demographics
NPI:1942802574
Name:PRESSLEY, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:PRESSLEY
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 1:904 COVENTRY AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3455
Mailing Address - Country:US
Mailing Address - Phone:419-515-9596
Mailing Address - Fax:
Practice Address - Street 1:904 COVENTRY AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-3455
Practice Address - Country:US
Practice Address - Phone:419-515-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 251S00000X
OH4810171376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251S00000XAgenciesCommunity/Behavioral Health