Healthcare Provider Details

I. General information

NPI: 1174865471
Provider Name (Legal Business Name): RACHEL SCOTT WOOTERS MA, RD, LDN,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD POB II, SUITE 326
CHESTER PA
19013-3902
US

IV. Provider business mailing address

1 MEDICAL CENTER BLVD POB II, SUITE
CHESTER PA
19013-3902
US

V. Phone/Fax

Practice location:
  • Phone: 610-619-8450
  • Fax: 610-619-8451
Mailing address:
  • Phone: 610-619-8455
  • Fax: 610-619-8451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number965013
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDN004026
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: