MEDICARE: DANIELLE ROSSER

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

General Provider Information

NPI Number	:	1194593954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ROSSER

Provider Business Mailing Address
First Line	:	2370 QUINLAND LAKE RD STE 140
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-7518
Country	:	US
Telephone Number	:	931-559-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2370 QUINLAND LAKE RD STE 140
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-7518
Country	:	US
Telephone Number	:	931-559-9222
Fax Number	:

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

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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Directions to “ DANIELLE ROSSER ” Practice Location

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