Healthcare Provider Details

I. General information

NPI: 1255654729
Provider Name (Legal Business Name): KATHERINE MARCELLE OTTO SPITZER RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE MARCELLE OTTO RD, LDN

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NORTHCREEK DR
CINCINNATI OH
45236-2377
US

IV. Provider business mailing address

8240 NORTHCREEK DR
CINCINNATI OH
45236-2377
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-7555
  • Fax:
Mailing address:
  • Phone: 513-246-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2952
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number08353
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: