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General NPI Number Information
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NPI Number | 1922022979
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Entity Type | Individual
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Provider Name | KATHLEEN SUE DETAMORE RD, LD
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 55 W WATERLOO RD
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City | AKRON
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State | OH
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Zip | 44319-1116
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Country | US
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Telephone | 330-724-7715
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Fax | 330-724-1080
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Provider Business Mailing Address
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Address Line | 56 TOWNSHIP ROAD 900
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City | WEST SALEM
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State | OH
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Zip | 44287-8729
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Country | US
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Telephone | 419-869-7527
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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 | 5709
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License Number State | OH
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