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NPI Code Detail

MEDICARE: STACI L FREEWORTH MNT

MEDICARE: STACI L FREEWORTH MNT
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
1133V00000XRegistered Dietitian5289OH

General Provider Information

NPI Number : 1043217995
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACI L FREEWORTH MNT
Provider Business Mailing Address
First Line : 2801 BAY PARK DR
Second Line :
City : OREGON
State : OH
Zip : 43616-4920
Country : US
Telephone Number : 419-690-7900
Fax Number :
Provider Business Practice Location Address
First Line : 2801 BAY PARK DR
Second Line :
City : OREGON
State : OH
Zip : 43616-4920
Country : US
Telephone Number : 419-690-7900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/08/2007

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Directions to “ STACI L FREEWORTH MNT” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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