MEDICARE: ABIGAIL PLOCH 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	DT86281	TX

General Provider Information

NPI Number	:	1245875798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL PLOCH RD

Provider Business Mailing Address
First Line	:	4501 SPICEWOOD SPRINGS RD STE 1022
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8543
Country	:	US
Telephone Number	:	512-257-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 SPICEWOOD SPRINGS RD STE 1022
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8543
Country	:	US
Telephone Number	:	512-257-0898
Fax Number	:

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/07/2019

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