Provider Demographics
NPI:1497215172
Name:RASBERRY, MAKAYLA M
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:M
Last Name:RASBERRY
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 1:4100 WESTBROOK DR APT 703
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-1260
Mailing Address - Country:US
Mailing Address - Phone:216-339-9192
Mailing Address - Fax:
Practice Address - Street 1:4100 WESTBROOK DR APT 703
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-1260
Practice Address - Country:US
Practice Address - Phone:216-339-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2488428Medicaid