MEDICARE: NUTRITION THERAPY CLINIC

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	133V00000X	Registered Dietitian	400	OH

General Provider Information

NPI Number	:	1891922597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUTRITION THERAPY CLINIC

Provider Business Mailing Address
First Line	:	1400 HERITAGE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-3305
Country	:	US
Telephone Number	:	937-435-4355
Fax Number	:	937-434-0102

Provider Business Practice Location Address
First Line	:	5563 FAR HILLS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-2225
Country	:	US
Telephone Number	:	937-435-4355
Fax Number	:	937-434-0102

Authorized Official
Title or Position	:	OWNER/DIETITIAN/DIABETES EDUCATOR
Name	:	MRS. MARA VELKERS LAMB
Credential	:	RD, LD, CDE,
Telephone Number	:	937-435-4355

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	06/19/2009

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Directions to “NUTRITION THERAPY CLINIC ” Practice Location

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