Healthcare Provider Details

I. General information

NPI: 1235701491
Provider Name (Legal Business Name): KEVIN P PIERCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 FRESNO DR
WESTLAKE OH
44145-2730
US

IV. Provider business mailing address

1102 FRESNO DR
WESTLAKE OH
44145-2730
US

V. Phone/Fax

Practice location:
  • Phone: 440-506-2002
  • Fax:
Mailing address:
  • Phone: 440-506-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: