Healthcare Provider Details

I. General information

NPI: 1245134014
Provider Name (Legal Business Name): KRISTIN RASBERRY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 N PERRY ST STE 100
OTTAWA OH
45875-1164
US

IV. Provider business mailing address

332 SUNSET ST
MENDON OH
45862-9590
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-9003
  • Fax: 419-523-9143
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: