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General NPI Number Information
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NPI Number | 1902417058
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Entity Type | Organization
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Legal Business Name | ON THE MOVE NUTRITION
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 9712 BALTIC RD
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City | CLEVELAND
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State | OH
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Zip | 44102-1719
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Country | US
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Telephone | 440-865-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 14837 DETROIT AVE STE 189
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City | LAKEWOOD
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State | OH
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Zip | 44107-3909
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Country | US
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Telephone | 440-865-1266
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA MARIE JURCAK
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Credential | MS, MPH, RD, LD
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Telephone | 440-865-1266
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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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