Provider Demographics
NPI:1821195280
Name:VESELSKY, MARIE L (RD,CDE)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:VESELSKY
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:SPERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:INTEGRATED OPTIMAL HEALTH
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-0606
Mailing Address - Country:US
Mailing Address - Phone:603-770-4856
Mailing Address - Fax:603-536-3513
Practice Address - Street 1:31 ROUTE 25 UNIT 2
Practice Address - Street 2:NINTH STATE MOVEMENT COMPLEX
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3159
Practice Address - Country:US
Practice Address - Phone:603-536-3513
Practice Address - Fax:603-536-3513
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH316OtherNH LICENSE
NH316OtherNH LICENSE