Healthcare Provider Details

I. General information

NPI: 1699639278
Provider Name (Legal Business Name): FALLON M CAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FALLON MICHELLE NICHOLS

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7732 OAKDALE ST NW
MASSILLON OH
44646-1942
US

IV. Provider business mailing address

7732 OAKDALE ST NW
MASSILLON OH
44646-1942
US

V. Phone/Fax

Practice location:
  • Phone: 863-331-5554
  • Fax:
Mailing address:
  • Phone: 863-331-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: