Provider Demographics
NPI:1174578090
Name:KESELMAN, INNA (MPT DCS)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:KESELMAN
Suffix:
Gender:F
Credentials:MPT DCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23302 E BAINTREE RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-382-5094
Mailing Address - Fax:
Practice Address - Street 1:27600 CHAGRIN BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-464-8460
Practice Address - Fax:216-360-8768
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT10413225100000X
OHOT05334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4170183Medicare PIN
OH4170181Medicare PIN
OH4101751Medicare PIN