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General NPI Number Information
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NPI Number | 1386816700
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Entity Type | Organization
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Legal Business Name | KEY THERAPY, PLLC
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 7145 SWINNEA RD SUITE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6380
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Country | US
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Telephone | 662-349-2370
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Fax | 662-349-2384
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Provider Business Mailing Address
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Address Line | PO BOX 552
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City | SOUTHAVEN
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State | MS
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Zip | 38671-0006
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Country | US
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Telephone | 662-349-2370
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Fax | 662-349-2384
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MIA J KIMMONS
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Credential | M.S. CCC-SLP
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Telephone | 662-349-2370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | S3061
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License Number State | MS
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