Provider Demographics
NPI:1134200082
Name:SATOLA, KELLY J (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:SATOLA
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 ROCKSIDE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2342
Mailing Address - Country:US
Mailing Address - Phone:216-973-8052
Mailing Address - Fax:216-524-9823
Practice Address - Street 1:6505 ROCKSIDE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2342
Practice Address - Country:US
Practice Address - Phone:216-973-8052
Practice Address - Fax:216-524-9823
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5354133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered