MEDICARE: ANITA DOCK RD LD LLC

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

General Provider Information

NPI Number	:	1437015724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANITA DOCK RD LD LLC

Provider Business Mailing Address
First Line	:	3589 CARPENTERS GREEN LN
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45241-3222
Country	:	US
Telephone Number	:	513-417-4769
Fax Number	:	513-938-1986

Provider Business Practice Location Address
First Line	:	4881 COOPER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-6902
Country	:	US
Telephone Number	:	513-417-4769
Fax Number	:	513-938-1986

Authorized Official
Title or Position	:	OWNER/DIETITIAN
Name	:	MRS. ANITA L DOCK
Credential	:	RDN
Telephone Number	:	513-417-4769

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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