Provider Demographics
NPI:1275380362
Name:RITTER, KELENE R
Entity Type:Individual
Prefix:
First Name:KELENE
Middle Name:R
Last Name:RITTER
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 1:2130 PORTAGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-9105
Mailing Address - Country:US
Mailing Address - Phone:330-324-0231
Mailing Address - Fax:
Practice Address - Street 1:2130 PORTAGE LINE RD
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-9105
Practice Address - Country:US
Practice Address - Phone:330-324-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services