MEDICARE: AUDREY F SCOTT RD,LD, CDE

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	864720	OH

General Provider Information

NPI Number	:	1568596476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY F SCOTT RD,LD, CDE

Provider Business Mailing Address
First Line	:	5202 BETHEL REED PARK
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1818
Country	:	US
Telephone Number	:	614-447-9495
Fax Number	:	614-447-9163

Provider Business Practice Location Address
First Line	:	5202 BETHEL REED PARK
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1818
Country	:	US
Telephone Number	:	614-447-9495
Fax Number	:	614-447-9163

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	10/31/2016

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