MEDICARE: MS. TARESSA M. KEBBEH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	253Z00000X	In Home Supportive Care Agency
3	315P00000X	Intellectual Disabilities Intermediate Care Facility
4	372600000X	Adult Companion
5	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
6	374U00000X	Home Health Aide
7	347C00000X	Private Vehicle
8	372500000X	Chore Provider
9	376J00000X	Homemaker
10	385HR2065X	Child Physical Disabilities Respite Care
11	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
12	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
13	172A00000X	Driver
14	172V00000X	Community Health Worker
15	174200000X	Meals Provider

General Provider Information

NPI Number	:	1871322321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARESSA M. KEBBEH

Provider Business Mailing Address
First Line	:	1110 WERTZ AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-2036
Country	:	US
Telephone Number	:	330-327-8011
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 WERTZ AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-2036
Country	:	US
Telephone Number	:	330-327-8011
Fax Number	:

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

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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