MEDICARE: MARISSA TESTA MS, RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist
2	133V00000X	Registered Dietitian	LD 7102	OH
3	133VN1004X	Pediatric Nutrition Registered Dietitian	7102	OH
4	133VN1006X	Metabolic Nutrition Registered Dietitian	7102	OH

General Provider Information

NPI Number	:	1811233992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA TESTA MS, RD, LD

Provider Business Mailing Address
First Line	:	1842 MERGANSER RUN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7017
Country	:	US
Telephone Number	:	614-946-8709
Fax Number	:

Provider Business Practice Location Address
First Line	:	1842 MERGANSER RUN DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-7017
Country	:	US
Telephone Number	:	614-946-8709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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