Healthcare Provider Details

I. General information

NPI: 1427888908
Provider Name (Legal Business Name): AMY KECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WASHINTON ST SUITE 150
MEDINA OH
44256
US

IV. Provider business mailing address

1065 SUNHAVEN DR
MEDINA OH
44256-3000
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-1069
  • Fax: 330-764-9712
Mailing address:
  • Phone: 330-749-6379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: