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General NPI Number Information
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NPI Number | 1235739574
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Entity Type | Organization
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Legal Business Name | MOTIVATED CONCEPTS, LLC
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 720 HOPMEADOW ST STE 4
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City | SIMSBURY
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State | CT
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Zip | 06070-2224
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Country | US
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Telephone | 860-324-8963
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SILVER BROOK LN
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City | NORTH GRANBY
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State | CT
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Zip | 06060-1111
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Country | US
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Telephone | 860-324-8963
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | AMY G WOODMAN
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Credential | RD
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Telephone | 860-324-8963
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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 |
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License Number State |
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