MEDICARE: KONTERRA LIFE

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

General Provider Information

NPI Number	:	1952097842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KONTERRA LIFE

Provider Business Mailing Address
First Line	:	C/O ONE SOURCE CONSULTING
Second Line	:	3901 CALVERTON BLVD STE 224
City	:	BELTSVILLE
State	:	MD
Zip	:	20705
Country	:	US
Telephone Number	:	301-412-5408
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 CALVERTON BLVD STE 224
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3407
Country	:	US
Telephone Number	:	301-412-5408
Fax Number	:

Authorized Official
Title or Position	:	RDN/OWNER
Name	:	KELA SEALS
Credential	:	RDN
Telephone Number	:	301-412-5408

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	03/10/2025

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Directions to “KONTERRA LIFE ” Practice Location

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