Healthcare Provider Details

I. General information

NPI: 1639239445
Provider Name (Legal Business Name): KEY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/13/2021
Certification Date: 03/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1394 JACKSON ST STE 201
SAINT PAUL MN
55117-4630
US

IV. Provider business mailing address

1394 JACKSON ST STE 201
SAINT PAUL MN
55117-4630
US

V. Phone/Fax

Practice location:
  • Phone: 651-603-8774
  • Fax: 651-603-9009
Mailing address:
  • Phone: 651-603-8774
  • Fax: 651-603-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. THERESA M BOWLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 651-784-7828