# WESTERN RESERVE PROFESSIONAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780768820
- **Authorized official:** KELLY SEMANCIK (ADIMINSTRATIVE DIRECTOR)
- **Authorized official phone:** (330) 677-3628

## Contact information

- **Practice address:** 401 DEVON PL, KENT, OH 44240-6482
- **Practice address phone:** (330) 677-3628
- **Practice address fax:** (330) 677-3626
- **Mailing address:** 307 W MAIN ST, KENT, OH 44240-2400
- **Mailing address phone:** (330) 677-3628
- **Mailing address fax:** (330) 677-3626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 08/22/2020