Provider Demographics
NPI:1083870059
Name:TALCOTT, KATHERYN ROSE (MS, RD, CDE, LD)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ROSE
Last Name:TALCOTT
Suffix:
Gender:F
Credentials:MS, RD, CDE, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:400 SUGAR CAMP CIR STE 205
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45409-1981
Practice Address - Country:US
Practice Address - Phone:937-395-3656
Practice Address - Fax:937-395-3657
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4341133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4317081Medicare PIN