MEDICARE: OLIVIA S. MYERS 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	LD09124	OH

General Provider Information

NPI Number	:	1982229654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA S. MYERS RD

Provider Business Mailing Address
First Line	:	1268 CITY PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206-3612
Country	:	US
Telephone Number	:	614-551-7402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1747 OLENTANGY RIVER RD # 1273
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-1453
Country	:	US
Telephone Number	:	614-551-7402
Fax Number	:

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

Provider Enumeration Date	:	06/09/2020
Last Update Date	:	02/13/2025

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