Provider Demographics
NPI:1578008678
Name:RAKOSKY, MEGAN (LMT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RAKOSKY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43440-2009
Mailing Address - Country:US
Mailing Address - Phone:419-341-3508
Mailing Address - Fax:
Practice Address - Street 1:818 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:OH
Practice Address - Zip Code:43440-2137
Practice Address - Country:US
Practice Address - Phone:419-341-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33023069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist