Healthcare Provider Details

I. General information

NPI: 1265010839
Provider Name (Legal Business Name): MICHELLE BOLTZ MS, RD, CSSD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N FORGE ST
AKRON OH
44304-1407
US

IV. Provider business mailing address

4537 RANCHWOOD RD
AKRON OH
44333-1335
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3000
  • Fax:
Mailing address:
  • Phone: 330-212-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number4270
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number4270
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number4270
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4270
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: