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General NPI Number Information
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NPI Number | 1265200216
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Entity Type | Organization
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Legal Business Name | FLOURISH & GROW NUTRITION SERVICES, LLC
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 419 MOODY ST STE 205
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City | WALTHAM
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State | MA
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Zip | 02453-0401
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Country | US
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Telephone | 781-738-0571
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Fax | 844-738-9026
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Provider Business Mailing Address
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Address Line | 419 MOODY ST STE 205
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City | WALTHAM
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State | MA
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Zip | 02453-0401
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Country | US
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Telephone | 781-738-0571
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Fax | 844-738-9026
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | KRISTIN OTTO
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Credential | MS, RD, LDN
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Telephone | 781-738-0571
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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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