MEDICARE: KATELYNN ROACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		OH

General Provider Information

NPI Number	:	1801511969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYNN ROACH

Provider Business Mailing Address
First Line	:	2291 VILLAGE PARK CT
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44906-1167
Country	:	US
Telephone Number	:	216-499-3436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2291 VILLAGE PARK CT
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44906-1167
Country	:	US
Telephone Number	:	216-499-3436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	04/10/2026

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Directions to “ KATELYNN ROACH ” Practice Location

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