Provider Demographics
NPI:1336629500
Name:ROSSELOT, MEGAN SU
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:SU
Last Name:ROSSELOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 GARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5429
Mailing Address - Country:US
Mailing Address - Phone:937-823-9208
Mailing Address - Fax:
Practice Address - Street 1:1155 GARWOOD DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-5429
Practice Address - Country:US
Practice Address - Phone:937-823-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist