MEDICARE: CASSIUS KELLEY

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	376J00000X	Homemaker	UB345166	OH

General Provider Information

NPI Number	:	1649041849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIUS KELLEY

Provider Business Mailing Address
First Line	:	2027 KEY ST APT J
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-2526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	736 MACKOW DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3164
Country	:	US
Telephone Number	:	419-932-1382
Fax Number	:

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

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/22/2025

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Directions to “ CASSIUS KELLEY ” Practice Location

Language	Start Address	Practice Location

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