MEDICARE: COURTNEY MARIE WRIGHT RD, LD, CPT

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	7290	OH

General Provider Information

NPI Number	:	1184289431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY MARIE WRIGHT RD, LD, CPT

Provider Business Mailing Address
First Line	:	4005 HARRISON AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-2237
Country	:	US
Telephone Number	:	330-413-1361
Fax Number	:

Provider Business Practice Location Address
First Line	:	7982 WHIPPLE AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-6930
Country	:	US
Telephone Number	:	330-499-2266
Fax Number	:

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

Provider Enumeration Date	:	05/02/2019
Last Update Date	:	05/02/2019

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