Provider Demographics
NPI:1588152698
Name:SCOTT, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-3521
Mailing Address - Country:US
Mailing Address - Phone:855-577-7284
Mailing Address - Fax:
Practice Address - Street 1:274 SUTTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:ID
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:885-577-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator