Provider Demographics
NPI:1801226857
Name:RAIS-KEELEY, PATRICIA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:RAIS-KEELEY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1520
Mailing Address - Country:US
Mailing Address - Phone:617-365-8257
Mailing Address - Fax:781-444-0079
Practice Address - Street 1:220-1 RESERVOIR STREET
Practice Address - Street 2:
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494
Practice Address - Country:US
Practice Address - Phone:617-365-8257
Practice Address - Fax:781-444-0079
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA292133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered