Provider Demographics
NPI:1811722382
Name:MOTE, MAISON BRILEY (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:MAISON
Middle Name:BRILEY
Last Name:MOTE
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 1:2500 ENFIELD RD APT 8
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3756
Mailing Address - Country:US
Mailing Address - Phone:281-217-9347
Mailing Address - Fax:
Practice Address - Street 1:2500 ENFIELD RD APT 8
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3756
Practice Address - Country:US
Practice Address - Phone:281-217-9347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT90698133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered