MEDICARE: KATHY WESTOVER MNT

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1548499403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY WESTOVER MNT

Provider Business Mailing Address
First Line	:	3609 KENYON DR
Second Line	:
City	:	FT. COLLINS
State	:	CO
Zip	:	80524
Country	:	US
Telephone Number	:	970-221-3152
Fax Number	:	970-484-8178

Provider Business Practice Location Address
First Line	:	3609 KENYON DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-1693
Country	:	US
Telephone Number	:	970-221-3152
Fax Number	:	970-484-8178

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

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	07/13/2009

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