Provider Demographics
NPI:1013344894
Name:OTTUM, MONA SCHULTZ (RD)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:SCHULTZ
Last Name:OTTUM
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 1:398 GREEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-8718
Mailing Address - Country:US
Mailing Address - Phone:734-260-0598
Mailing Address - Fax:734-401-6002
Practice Address - Street 1:398 GREEN HILLS DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-8718
Practice Address - Country:US
Practice Address - Phone:734-260-0598
Practice Address - Fax:734-401-6002
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered