Basic Information
| Provider Information | |||||||||
| NPI: | 1265010839 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLTZ | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, RD, CSSD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4537 RANCHWOOD RD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443331335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302127009 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 141 N FORGE ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2021 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | 4270 | OH | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133VN1201X | 4270 | OH | N | 133VN1501X | 4270 | OH | N | 133V00000X | 4270 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.