Healthcare Provider Details

I. General information

NPI: 1881112845
Provider Name (Legal Business Name): MATTHEW CALDWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6279 FRANK AVE NW
NORTH CANTON OH
44720-7227
US

IV. Provider business mailing address

6279 FRANK AVE NW
NORTH CANTON OH
44720-7227
US

V. Phone/Fax

Practice location:
  • Phone: 330-305-1668
  • Fax:
Mailing address:
  • Phone: 330-305-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: