=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063233187
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDALL RAE KASPER RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1912 HAYES AVE
-----------------------------------------------------
City | SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44870-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-502-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2007 CEDAR POINT RD
-----------------------------------------------------
City | SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44870-5251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-466-6395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | LD.09387
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------