Provider Demographics
NPI:1891884722
Name:OTTINGER, ROSE M (RD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:OTTINGER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:MCCREARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:130 BEACH ANN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1737
Mailing Address - Country:US
Mailing Address - Phone:636-528-7989
Mailing Address - Fax:
Practice Address - Street 1:1000 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1513
Practice Address - Country:US
Practice Address - Phone:636-528-3348
Practice Address - Fax:636-528-3312
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000624133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered