Provider Demographics
NPI:1700139235
Name:ROSENGARTEN, KELLI LYNN
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:LYNN
Last Name:ROSENGARTEN
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 1:2758 ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-9255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1880 N PERRY ST
Practice Address - Street 2:STE 100
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1139
Practice Address - Country:US
Practice Address - Phone:419-523-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008141225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2251343Medicaid
OH2251343Medicaid