Healthcare Provider Details

I. General information

NPI: 1235739574
Provider Name (Legal Business Name): MOTIVATED CONCEPTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HOPMEADOW ST STE 4
SIMSBURY CT
06070-2224
US

IV. Provider business mailing address

1 SILVER BROOK LN
NORTH GRANBY CT
06060-1111
US

V. Phone/Fax

Practice location:
  • Phone: 860-324-8963
  • Fax:
Mailing address:
  • Phone: 860-324-8963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: AMY G WOODMAN
Title or Position: DIETITIAN
Credential: RD
Phone: 860-324-8963