Provider Demographics
NPI:1205414406
Name:KOEHLE, MEGAN M (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:KOEHLE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HOWARD AVENUE
Mailing Address - Street 2:DIETITIAN'S OFFICE, 4TH FLOOR
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601
Mailing Address - Country:US
Mailing Address - Phone:814-889-3976
Mailing Address - Fax:
Practice Address - Street 1:620 HOWARD AVENUE
Practice Address - Street 2:DIETITIAN'S OFFICE, 4TH FLOOR
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601
Practice Address - Country:US
Practice Address - Phone:814-889-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006033133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered