MEDICARE: CATHERINE JANE BRATKA RD, 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
1	133V00000X	Registered Dietitian	LD 6182	OH

General Provider Information

NPI Number	:	1346419207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE JANE BRATKA RD, LD

Provider Business Mailing Address
First Line	:	3406 LENOX VILLAGE DR
Second Line	:	#244
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-4442
Country	:	US
Telephone Number	:	330-714-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 LENOX VILLAGE DR
Second Line	:	#244
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-4442
Country	:	US
Telephone Number	:	330-714-7049
Fax Number	:

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

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	11/29/2012

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