MEDICARE: GRACE PAULINA THOMAS RDN

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	133VN1501X	Sports Dietetics Nutrition Registered Dietitian	86292912	OH
2	133VN1501X	Sports Dietetics Nutrition Registered Dietitian	DX8337	MD

General Provider Information

NPI Number	:	1508635970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE PAULINA THOMAS RDN

Provider Business Mailing Address
First Line	:	6515 MOHICAN DR
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-8594
Country	:	US
Telephone Number	:	614-940-3175
Fax Number	:

Provider Business Practice Location Address
First Line	:	6515 MOHICAN DR
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-8594
Country	:	US
Telephone Number	:	614-940-3175
Fax Number	:

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

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	03/18/2026

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Directions to “ GRACE PAULINA THOMAS RDN” Practice Location

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