MEDICARE: MOLLY BETH KEITH PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1902097728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY BETH KEITH PSYD

Provider Business Mailing Address
First Line	:	4141 GREEN CLOVER DR
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-2250
Country	:	US
Telephone Number	:	925-209-1409
Fax Number	:

Provider Business Practice Location Address
First Line	:	6640 PERIMETER DR
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-8030
Country	:	US
Telephone Number	:	380-240-9150
Fax Number	:	380-240-9151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	09/28/2025

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