Provider Demographics
NPI:1740306075
Name:MOTL, JENNIFER L (RD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:MOTL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5591 ANGLE LN
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1306
Mailing Address - Country:US
Mailing Address - Phone:262-995-8306
Mailing Address - Fax:414-423-8049
Practice Address - Street 1:2025 E NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2906
Practice Address - Country:US
Practice Address - Phone:414-961-3654
Practice Address - Fax:414-961-4044
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered