Provider Demographics
NPI:1801027511
Name:MUZILLA, MICHELE MARIE (RD LD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MARIE
Last Name:MUZILLA
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 1:790 ARCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8832
Mailing Address - Country:US
Mailing Address - Phone:330-285-2471
Mailing Address - Fax:234-702-0132
Practice Address - Street 1:790 ARCHWOOD RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8832
Practice Address - Country:US
Practice Address - Phone:330-285-2471
Practice Address - Fax:234-702-0132
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 5579133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered