Provider Demographics
NPI:1952097842
Name:KONTERRA LIFE
Entity type:Organization
Organization Name:KONTERRA LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:301-412-5408
Mailing Address - Street 1:C/O ONE SOURCE CONSULTING
Mailing Address - Street 2:3901 CALVERTON BLVD STE 224
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:301-412-5408
Mailing Address - Fax:
Practice Address - Street 1:3901 CALVERTON BLVD STE 224
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3407
Practice Address - Country:US
Practice Address - Phone:301-412-5408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty