Provider Demographics
NPI:1881832590
Name:BOOTH, MELISSA TURNER (RD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:TURNER
Last Name:BOOTH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 THURSTON ST
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1609
Mailing Address - Country:US
Mailing Address - Phone:508-384-3801
Mailing Address - Fax:
Practice Address - Street 1:406 THURSTON ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1609
Practice Address - Country:US
Practice Address - Phone:508-384-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1258133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered