Healthcare Provider Details

I. General information

NPI: 1669994620
Provider Name (Legal Business Name): KENT STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MIDWAY DR MACC ANX RM 123
KENT OH
44242-0001
US

IV. Provider business mailing address

1500 EASTWAY DR
KENT OH
44242-0001
US

V. Phone/Fax

Practice location:
  • Phone: 330-672-8426
  • Fax:
Mailing address:
  • Phone: 330-672-8194
  • Fax: 330-672-3711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE A VOLCHECK
Title or Position: DIRECTOR
Credential:
Phone: 330-672-8194