Provider Demographics
NPI:1306189238
Name:MAKO, LEAH (RD/LD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MAKO
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD
Mailing Address - Street 1:445 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:BLDG N
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3192
Mailing Address - Country:US
Mailing Address - Phone:614-293-9204
Mailing Address - Fax:614-293-9549
Practice Address - Street 1:445 E DUBLIN GRANVILLE RD
Practice Address - Street 2:BLDG N
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3192
Practice Address - Country:US
Practice Address - Phone:614-293-9204
Practice Address - Fax:614-293-9549
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD6847133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered