Provider Demographics
NPI:1164294385
Name:TRISSEL, WILLIAM CARL
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARL
Last Name:TRISSEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4442 LOGAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-1479
Mailing Address - Country:US
Mailing Address - Phone:330-268-2720
Mailing Address - Fax:
Practice Address - Street 1:4442 LOGAN AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-1479
Practice Address - Country:US
Practice Address - Phone:330-268-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health