Provider Demographics
NPI:1235536145
Name:VESCO, COURTENEY
Entity Type:Individual
Prefix:
First Name:COURTENEY
Middle Name:
Last Name:VESCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 SHERRICK RD SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3531
Mailing Address - Country:US
Mailing Address - Phone:330-697-5193
Mailing Address - Fax:
Practice Address - Street 1:1326 SHERRICK RD SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3531
Practice Address - Country:US
Practice Address - Phone:330-697-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21027890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist