Provider Demographics
NPI:1346419207
Name:BRATKA, CATHERINE JANE (RD, LD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JANE
Last Name:BRATKA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 LENOX VILLAGE DR
Mailing Address - Street 2:#244
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4442
Mailing Address - Country:US
Mailing Address - Phone:330-714-7049
Mailing Address - Fax:
Practice Address - Street 1:3406 LENOX VILLAGE DR
Practice Address - Street 2:#244
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4442
Practice Address - Country:US
Practice Address - Phone:330-714-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 6182133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered