MEDICARE: ROSALYN KOTLYN RN

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	163WH0200X	Home Health Registered Nurse	RN.270403	OH

General Provider Information

NPI Number	:	1427843549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN KOTLYN RN

Provider Business Mailing Address
First Line	:	1414 HONEYGOLD LN
Second Line	:
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-3630
Country	:	US
Telephone Number	:	440-570-7266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 HONEYGOLD LN
Second Line	:
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-3630
Country	:	US
Telephone Number	:	440-570-7266
Fax Number	:

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

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/10/2025

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