Healthcare Provider Details

I. General information

NPI: 1477971323
Provider Name (Legal Business Name): MICHELE LAROCK MS RDN LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RESEARCH DR
AMHERST MA
01002-2788
US

IV. Provider business mailing address

12 SUNSET AVE
HATFIELD MA
01038-9716
US

V. Phone/Fax

Practice location:
  • Phone: 413-570-3281
  • Fax:
Mailing address:
  • Phone: 413-570-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1968
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: