Healthcare Provider Details

I. General information

NPI: 1114551389
Provider Name (Legal Business Name): ASHLEIGH LAUREN ROVTAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S MAIN ST
PROSPECT OH
43342-9304
US

IV. Provider business mailing address

204 SUMMIT ST
MARION OH
43302-4210
US

V. Phone/Fax

Practice location:
  • Phone: 740-262-2679
  • Fax:
Mailing address:
  • Phone: 740-262-2679
  • 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: