Provider Demographics
NPI:1235701491
Name:PIERCE, KEVIN P
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:PIERCE
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 1:1102 FRESNO DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2730
Mailing Address - Country:US
Mailing Address - Phone:440-506-2002
Mailing Address - Fax:
Practice Address - Street 1:1102 FRESNO DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2730
Practice Address - Country:US
Practice Address - Phone:440-506-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care