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NPI Code Detail

MEDICARE: KELLY ANGEVINE

MEDICARE: KELLY ANGEVINE
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
1171M00000XCase Manager/Care CoordinatorOH
2106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100000OTHEROHLICENSURE BOARD

General Provider Information

NPI Number : 1336741552
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANGEVINE
Provider Business Mailing Address
First Line : 4721 READING RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45237-6107
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4721 READING RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45237-6107
Country : US
Telephone Number : 855-577-7284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2020
Last Update Date : 02/05/2026

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