# MS. MARILYN ROSTER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154642668
- **Gender:** F
- **Credential:** PTA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171W00000X | Contractor | 5502002750 | MI | Yes |
| 171W00000X | Contractor | PTA.07103 | OH | — |

## Other

- **Enumeration date:** 06/18/2010
- **Last updated:** 06/17/2019