Provider Demographics
NPI:1407449143
Name:THORLA, PAGE KAGAFAS (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:PAGE
Middle Name:KAGAFAS
Last Name:THORLA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CASTERTON AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1001
Mailing Address - Country:US
Mailing Address - Phone:330-802-5221
Mailing Address - Fax:
Practice Address - Street 1:103 CASTERTON AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1001
Practice Address - Country:US
Practice Address - Phone:330-802-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09143133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered