Healthcare Provider Details

I. General information

NPI: 1730215823
Provider Name (Legal Business Name): SOCIETY FOR REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 LAKE SHORE BLVD
MENTOR OH
44060-1613
US

IV. Provider business mailing address

9521 LAKE SHORE BLVD
MENTOR OH
44060-1613
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-8993
  • Fax: 440-352-6632
Mailing address:
  • Phone: 440-352-8993
  • Fax: 440-352-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA00987
License Number StateOH

VIII. Authorized Official

Name: MR. RICHARD J. KESSLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 440-352-8993