Provider Demographics
NPI:1275197113
Name:CAROSELLA, TERESE L
Entity Type:Individual
Prefix:MS
First Name:TERESE
Middle Name:L
Last Name:CAROSELLA
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 1:6377 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3871
Mailing Address - Country:US
Mailing Address - Phone:216-440-1259
Mailing Address - Fax:
Practice Address - Street 1:6377 WOLF RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-3871
Practice Address - Country:US
Practice Address - Phone:216-440-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion