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General NPI Number Information
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NPI Number | 1336072586
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Entity Type | Individual
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Provider Name | KELLEY SUE WINLAND DSP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2026
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Last Update Date | 06/06/2026
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Provider Practice Location Address
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Address Line | 206 11TH ST NE
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City | MASSILLON
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State | OH
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Zip | 44646-8444
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Country | US
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Telephone | 330-605-6588
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Fax |
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Provider Business Mailing Address
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Address Line | 165 ELM ST NE
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City | BREWSTER
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State | OH
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Zip | 44613-1005
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Country | US
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Telephone | 330-605-6588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | RR351290
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License Number State | OH
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