MEDICARE: KELLEY SUE WINLAND DSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	RR351290	OH

General Provider Information

NPI Number	:	1336072586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY SUE WINLAND DSP

Provider Business Mailing Address
First Line	:	165 ELM ST NE
Second Line	:
City	:	BREWSTER
State	:	OH
Zip	:	44613-1005
Country	:	US
Telephone Number	:	330-605-6588
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 11TH ST NE
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44646-8444
Country	:	US
Telephone Number	:	330-605-6588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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Directions to “ KELLEY SUE WINLAND DSP” Practice Location

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