MEDICARE: MISS JANELLE FRALEY 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	86003763	OH

General Provider Information

NPI Number	:	1588094056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JANELLE FRALEY RD, LD

Provider Business Mailing Address
First Line	:	2489 OVERLOOK RD
Second Line	:	APT 411
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-5600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1456 PARK AVE W
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44906-2700
Country	:	US
Telephone Number	:	419-529-4602
Fax Number	:

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

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	11/20/2013

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