Healthcare Provider Details

I. General information

NPI: 1245711282
Provider Name (Legal Business Name): KELLY R OVERCASHER AUD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6647 FRANK AVE NW
NORTH CANTON OH
44720-7259
US

IV. Provider business mailing address

6647 FRANK AVE NW
NORTH CANTON OH
44720-7259
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-8348
  • Fax: 330-494-8356
Mailing address:
  • Phone: 330-494-8348
  • Fax: 330-494-8356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: KELLY R OVERCASHER
Title or Position: OWNER
Credential: AUD
Phone: 330-494-8348