Provider Demographics
NPI:1871686741
Name:OSWALT, KATHLEEN ELENA (MS, RDN, LD, CLT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ELENA
Last Name:OSWALT
Suffix:
Gender:F
Credentials:MS, RDN, LD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 TIBBETT CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6156
Mailing Address - Country:US
Mailing Address - Phone:843-860-8866
Mailing Address - Fax:
Practice Address - Street 1:2105 TIBBETT CT
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-860-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered