Provider Demographics
NPI:1467858993
Name:MARASEK, SAMANTHA N (RD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:N
Last Name:MARASEK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:N
Other - Last Name:PATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-1000
Mailing Address - Fax:606-433-1867
Practice Address - Street 1:1098 S MAYO TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1546
Practice Address - Country:US
Practice Address - Phone:606-218-1000
Practice Address - Fax:606-433-1867
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83315133V00000X
KYBDNDTN00221252133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT83315OtherDIETICIAN