MEDICARE: JODY MORRELL RILEY 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	5282	OH

General Provider Information

NPI Number	:	1750586046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY MORRELL RILEY RD,LD

Provider Business Mailing Address
First Line	:	2630 VILLAGE PIER LN
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-7902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1864
Country	:	US
Telephone Number	:	614-451-1910
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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