Healthcare Provider Details

I. General information

NPI: 1821195280
Provider Name (Legal Business Name): MARIE L. VESELSKY R.D.,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE SPERL R.D.

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ROUTE 25 UNIT 2 NINTH STATE MOVEMENT COMPLEX
PLYMOUTH NH
03264-3159
US

IV. Provider business mailing address

PO BOX 606 INTEGRATED OPTIMAL HEALTH
PLYMOUTH NH
03264-0606
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-3513
  • Fax: 603-536-3513
Mailing address:
  • Phone: 603-770-4856
  • Fax: 603-536-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: