Healthcare Provider Details

I. General information

NPI: 1336072586
Provider Name (Legal Business Name): KELLEY SUE WINLAND DSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 11TH ST NE
MASSILLON OH
44646-8444
US

IV. Provider business mailing address

165 ELM ST NE
BREWSTER OH
44613-1005
US

V. Phone/Fax

Practice location:
  • Phone: 330-605-6588
  • Fax:
Mailing address:
  • Phone: 330-605-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberRR351290
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: