Provider Demographics
NPI:1619103777
Name:MOTTO, MICHELLE B (RD,LD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:B
Last Name:MOTTO
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 1:3000 HUNDERTMARK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1150
Mailing Address - Country:US
Mailing Address - Phone:952-361-0042
Mailing Address - Fax:952-361-4369
Practice Address - Street 1:3000 HUNDERTMARK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1150
Practice Address - Country:US
Practice Address - Phone:952-361-0042
Practice Address - Fax:952-361-4369
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2813133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered