Provider Demographics
NPI:1114967916
Name:TOTAL NUTRITION THERAPY LLC
Entity Type:Organization
Organization Name:TOTAL NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:ORIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LD CDE
Authorized Official - Phone:513-477-4270
Mailing Address - Street 1:7407 INDIAN RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005
Mailing Address - Country:US
Mailing Address - Phone:513-477-4270
Mailing Address - Fax:859-586-7017
Practice Address - Street 1:7407 INDIAN RIDGE WAY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005
Practice Address - Country:US
Practice Address - Phone:513-477-4270
Practice Address - Fax:859-586-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5270133V00000X
KYKY051861133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000375129OtherANTHEM BLUE CROSS BLUE SH
KY9683Medicare ID - Type UnspecifiedADMINISTAR FEDERAL
OH000000375129OtherANTHEM BLUE CROSS BLUE SH