Healthcare Provider Details

I. General information

NPI: 1457852048
Provider Name (Legal Business Name): ALLISON WRAYE OSINEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TUSCARAWAS ST W STE 200
CANTON OH
44702-2044
US

IV. Provider business mailing address

400 TUSCARAWAS ST W STE 200
CANTON OH
44702-2044
US

V. Phone/Fax

Practice location:
  • Phone: 330-438-4846
  • Fax: 330-438-3003
Mailing address:
  • Phone: 330-438-4846
  • Fax: 330-438-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1901515-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: