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NPI Code Detail

MEDICARE: KATHERYN ROSE TALCOTT MS, RD, CDE, LD

MEDICARE: KATHERYN ROSE TALCOTT MS, RD, CDE, LD
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
1133NN1002XNutrition Education Nutritionist4341OH

General Provider Information

NPI Number : 1083870059
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERYN ROSE TALCOTT MS, RD, CDE, LD
Provider Business Mailing Address
First Line : 3170 KETTERING BLVD BLDG B
Second Line :
City : MORAINE
State : OH
Zip : 45439-1924
Country : US
Telephone Number : 937-991-3188
Fax Number : 937-223-9811
Provider Business Practice Location Address
First Line : 400 SUGAR CAMP CIR STE 205
Second Line :
City : OAKWOOD
State : OH
Zip : 45409-1981
Country : US
Telephone Number : 937-395-3656
Fax Number : 937-395-3657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2008
Last Update Date : 02/04/2022

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