Provider Demographics
NPI:1164061487
Name:KESSLER, CODY MICHAEL
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:MICHAEL
Last Name:KESSLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:MICHAEL
Other - Last Name:WEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1033 LARCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2424
Mailing Address - Country:US
Mailing Address - Phone:419-747-4122
Mailing Address - Fax:419-747-4126
Practice Address - Street 1:1033 LARCHWOOD RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2424
Practice Address - Country:US
Practice Address - Phone:419-747-4122
Practice Address - Fax:419-747-4126
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician