Healthcare Provider Details

I. General information

NPI: 1548593791
Provider Name (Legal Business Name): UNIVERSAL REHABILITATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 PROMWAY AVE NW
NORTH CANTON OH
44720-7321
US

IV. Provider business mailing address

6975 PROMWAY AVE NW
NORTH CANTON OH
44720-7321
US

V. Phone/Fax

Practice location:
  • Phone: 330-305-6760
  • Fax: 330-305-6765
Mailing address:
  • Phone: 330-305-6760
  • Fax: 330-305-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number05821
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code224ZE0001X
TaxonomyEnvironmental Modification Occupational Therapy Assistant
License Number05821
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number05821
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number05821
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number05821
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number05821
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number05821
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05821
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number05821
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number05821
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number05821
License Number StateOH
# 12
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number05821
License Number StateOH
# 13
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number05821
License Number StateOH
# 14
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number05821
License Number StateOH
# 15
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05821
License Number StateOH

VIII. Authorized Official

Name: MRS. MELICENT BUSSEY
Title or Position: PT/OWNER
Credential: PT, CLT, WCC
Phone: 330-305-6760