Provider Demographics
NPI:1902493596
Name:MARQUAND, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:MARQUAND
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 1:1622 N COAST HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-2357
Mailing Address - Country:US
Mailing Address - Phone:541-272-5015
Mailing Address - Fax:541-272-5016
Practice Address - Street 1:1622 N COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-2357
Practice Address - Country:US
Practice Address - Phone:541-272-5015
Practice Address - Fax:541-272-5016
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10128388237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist