Individual
BEVERLY TATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., L.D.
Contact information
Practice address
2801 BAY PARK DR, OREGON, OH 43616-4920
(419) 690-8722
Mailing address
2801 BAY PARK DR, OREGON, OH 43616-4920
(419) 690-8722
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
6806
OH
Other
Enumeration date
11/29/2011
Last updated
11/29/2011
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