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General NPI Number Information
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NPI Number | 1972420123
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Entity Type | Organization
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Legal Business Name | OPEN TABLE NUTRITION LLC
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 117 S LEXINGTON ST STE 100
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City | HARRISONVILLE
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State | MO
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Zip | 64701-2443
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Country | US
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Telephone | 314-282-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 117 S LEXINGTON ST STE 100
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City | HARRISONVILLE
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State | MO
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Zip | 64701-2443
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Country | US
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Telephone | 314-282-5181
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JACLYN ALVAREZ
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Credential | MS, RDN, CSOWM, LD
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Telephone | 918-282-6313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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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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