MEDICARE: DIANE KAEMMER R.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	000689	CT

General Provider Information

NPI Number	:	1043548837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE KAEMMER R.D

Provider Business Mailing Address
First Line	:	135 TOWN ST
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423-1458
Country	:	US
Telephone Number	:	860-873-3561
Fax Number	:	860-873-3561

Provider Business Practice Location Address
First Line	:	135 TOWN ST
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423-1458
Country	:	US
Telephone Number	:	860-873-3561
Fax Number	:	860-873-3561

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

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	12/07/2009

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