MEDICARE: REGINA FELDKAMP 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	LD3629	OH
2	133V00000X	Registered Dietitian	BDNDTN00218831	KY

General Provider Information

NPI Number	:	1376925347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA FELDKAMP RD,LD

Provider Business Mailing Address
First Line	:	555 VIRGINIA LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1349
Country	:	US
Telephone Number	:	513-706-2495
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 VIRGINIA LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-1349
Country	:	US
Telephone Number	:	513-706-2495
Fax Number	:

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

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/25/2015

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