Provider Demographics
NPI:1184004574
Name:OSSOLINSKI, KATHERINE (MS, RD, CSO, LD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:OSSOLINSKI
Suffix:
Gender:F
Credentials:MS, RD, CSO, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 WHIT DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4039
Mailing Address - Country:US
Mailing Address - Phone:718-908-7345
Mailing Address - Fax:706-850-4541
Practice Address - Street 1:1015 WHIT DAVIS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-4039
Practice Address - Country:US
Practice Address - Phone:718-908-7345
Practice Address - Fax:706-850-4541
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered