Provider Demographics
NPI:1467179515
Name:HASELROTH, MEILSSA A
Entity Type:Individual
Prefix:
First Name:MEILSSA
Middle Name:A
Last Name:HASELROTH
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 1:949 WESTLAND DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1430
Mailing Address - Country:US
Mailing Address - Phone:213-908-4388
Mailing Address - Fax:
Practice Address - Street 1:949 WESTLAND DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1430
Practice Address - Country:US
Practice Address - Phone:213-908-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9999999Medicaid