Individual
MRS. KELLY JO WITTWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12049 BANDY RD, ALLIANCE, OH 44601-9212
(330) 584-2150
Mailing address
12049 BANDY RD, ALLIANCE, OH 44601-9212
(330) 584-2150
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
401189970111
OH
Other
Enumeration date
04/29/2012
Last updated
04/29/2012
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