Healthcare Provider Details

I. General information

NPI: 1265037709
Provider Name (Legal Business Name): OLIVIA SPOERL POSTICH JACKSON MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA POSTICH

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 O MALLEY DRIVE APT 505
PARMA OH
44134
US

IV. Provider business mailing address

500 O MALLEY DRIVE APT 505
PARMA OH
44134
US

V. Phone/Fax

Practice location:
  • Phone: 419-265-3025
  • Fax:
Mailing address:
  • Phone: 419-265-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.09276
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: