Provider Demographics
NPI:1336443431
Name:MATTOX, KATHERINE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MATTOX
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2889 ROMANA PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2023
Mailing Address - Country:US
Mailing Address - Phone:513-260-5581
Mailing Address - Fax:
Practice Address - Street 1:2889 ROMANA PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2023
Practice Address - Country:US
Practice Address - Phone:513-260-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5953133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic