Healthcare Provider Details

I. General information

NPI: 1003114109
Provider Name (Legal Business Name): KIDS@HOME THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 27TH ST NE
CANTON OH
44714-1703
US

IV. Provider business mailing address

701 27TH ST NE
CANTON OH
44714-1703
US

V. Phone/Fax

Practice location:
  • Phone: 330-705-9334
  • Fax: 330-456-9941
Mailing address:
  • Phone: 330-705-9334
  • Fax: 330-456-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5140
License Number StateOH

VIII. Authorized Official

Name: MARY ELLEN VALENTINO
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PHYSICAL THERAPIST
Phone: 330-705-9334