Healthcare Provider Details

I. General information

NPI: 1497215172
Provider Name (Legal Business Name): MAKAYLA M RASBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 WESTBROOK DR APT 703
BROOKLYN OH
44144-1260
US

IV. Provider business mailing address

4100 WESTBROOK DR APT 703
BROOKLYN OH
44144-1260
US

V. Phone/Fax

Practice location:
  • Phone: 216-339-9192
  • Fax:
Mailing address:
  • Phone: 216-339-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: