Healthcare Provider Details

I. General information

NPI: 1144957093
Provider Name (Legal Business Name): MICHELLE KJELL RD/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQUARE AKRON CHILDRENS HOSPITAL
AKRON OH
44308
US

IV. Provider business mailing address

1 PERKINS SQUARE AKRON CHILDRENS HOSPITAL
AKRON OH
44308
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8625
  • Fax:
Mailing address:
  • Phone: 330-543-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD5761
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: