Provider Demographics
NPI:1093134819
Name:RABALAIS, MARLA (RD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:RABALAIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 PROVIDENCE POINT DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-2973
Mailing Address - Country:US
Mailing Address - Phone:864-517-2817
Mailing Address - Fax:
Practice Address - Street 1:609 PROVIDENCE POINT DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2973
Practice Address - Country:US
Practice Address - Phone:864-517-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC123133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered