Healthcare Provider Details

I. General information

NPI: 1609770791
Provider Name (Legal Business Name): AMY GROTTLA RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1815
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1873
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-4364
  • Fax: 937-641-5909
Mailing address:
  • Phone: 937-641-4364
  • Fax: 937-641-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86445579
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: