Provider Demographics
NPI:1194011726
Name:OKADA, TOMOKO (MS, RD, CNSC, CDN)
Entity Type:Individual
Prefix:
First Name:TOMOKO
Middle Name:
Last Name:OKADA
Suffix:
Gender:F
Credentials:MS, RD, CNSC, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 RIDGETREE TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5944
Mailing Address - Country:US
Mailing Address - Phone:917-566-2151
Mailing Address - Fax:
Practice Address - Street 1:1451 RIDGETREE TRAILS DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63021-5944
Practice Address - Country:US
Practice Address - Phone:917-566-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006498-1133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic