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General NPI Number Information
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NPI Number | 1356308407
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Entity Type | Organization
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Legal Business Name | WESTERN RESERVE PROFESS
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 307 W MAIN ST
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City | KENT
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State | OH
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Zip | 44240-2400
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Country | US
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Telephone | 330-677-3628
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Fax | 330-677-3626
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Provider Business Mailing Address
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Address Line | PO BOX 951971
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City | CLEVELAND
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State | OH
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Zip | 44193-0021
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Country | US
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Telephone | 330-548-0080
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Fax | 330-548-0084
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | KELLY ANN SEMANCIK
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Credential |
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Telephone | 330-677-3628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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