Provider Demographics
NPI:1861673824
Name:ROTAR, MEGAN HOLLY (TLLP)
Entity Type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:HOLLY
Last Name:ROTAR
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6729
Mailing Address - Country:US
Mailing Address - Phone:248-601-3111
Mailing Address - Fax:
Practice Address - Street 1:425 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-6729
Practice Address - Country:US
Practice Address - Phone:248-601-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013549103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist