Provider Demographics
NPI:1114296720
Name:AYRES, MARCY J (RD)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:J
Last Name:AYRES
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 1:3949 SOUTH 6TH ST.
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4746
Mailing Address - Country:US
Mailing Address - Phone:541-882-1487
Mailing Address - Fax:541-882-1670
Practice Address - Street 1:330 CHILOQUIN BLVD.
Practice Address - Street 2:
Practice Address - City:CHILOQUIN
Practice Address - State:OR
Practice Address - Zip Code:97624
Practice Address - Country:US
Practice Address - Phone:541-882-1487
Practice Address - Fax:541-783-3273
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1016943133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered