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General NPI Number Information
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NPI Number | 1134433618
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Entity Type | Individual
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Provider Name | TARA L. SPISAK RD, LD, CDE
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Gender | Female
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 121 WESTFIELD DR STE 1
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City | ARCHBOLD
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State | OH
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Zip | 43502-1005
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Country | US
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Telephone | 419-445-2015
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Fax | 419-445-8102
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Provider Business Mailing Address
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Address Line | 11109 PARKVIEW PLAZA DR # 117
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD.4906
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License Number State | OH
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