=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265990964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANA D KEY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2019
-----------------------------------------------------
Last Update Date | 03/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 W 9TH ST
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74834-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-258-6161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 W 9TH ST
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74834-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-258-6161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DANA DAWN KEY
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 405-258-6161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------