MEDICARE: HEATHER COLLEEN MCCORMICK M.S., R.D., L.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	5422	OH

General Provider Information

NPI Number	:	1033228952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER COLLEEN MCCORMICK M.S., R.D., L.D.

Provider Business Mailing Address
First Line	:	272 KENBROOK DR
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-3613
Country	:	US
Telephone Number	:	614-580-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1699 W MOUND ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1809
Country	:	US
Telephone Number	:	614-437-2880
Fax Number	:	614-278-3143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/03/2013

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