Organization
WESTERN RESERVE PROFESSIONAL GROUP INC
Active
Other names
OCC MED SOURCE
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY ANN SEMANCIK (ADMINISTRATIVE DIRECTOR)
(330) 548-0080
Entity
Organization
Contact information
Practice address
174 CURRIE HALL PKWY, STE D, KENT, OH 44240-4387
(330) 548-0086
(330) 548-0085
Mailing address
PO BOX 951971, CLEVELAND, OH 44193-0021
(330) 548-0080
(330) 548-0085
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0670573
—
OH
Enumeration date
05/01/2006
Last updated
08/22/2020
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