MEDICARE: MS. AMY FILLMORE REEDER RD

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	371273-4901	UT

General Provider Information

NPI Number	:	1083631436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY FILLMORE REEDER RD

Provider Business Mailing Address
First Line	:	927 BROWNING AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2307
Country	:	US
Telephone Number	:	801-746-0776
Fax Number	:	801-746-0775

Provider Business Practice Location Address
First Line	:	807 E SOUTH TEMPLE
Second Line	:	STE 101
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1339
Country	:	US
Telephone Number	:	801-746-0776
Fax Number	:	801-746-0775

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	12/01/2021

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