MEDICARE: KATHERINE OETKEN RD

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972075414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE OETKEN RD

Provider Business Mailing Address
First Line	:	4001 WATONGA BLVD APT 3211
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-5346
Country	:	US
Telephone Number	:	210-310-8292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 SHORELINE DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-0128
Country	:	US
Telephone Number	:	940-383-1240
Fax Number	:

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

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	12/21/2018

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Directions to “ KATHERINE OETKEN RD” Practice Location

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