=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477481760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIA CHIECCHIO MS, RDN, LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2026
-----------------------------------------------------
Last Update Date | 05/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9380 MAIN ST
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-7657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-206-1131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6972 TARRAGON CT
-----------------------------------------------------
City | LIBERTY TWP
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45011-9390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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.11642
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------