Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 136A00000X | Dietetic Technician, Registered | | | | No |
| 2 | 133V00000X | Dietitian, Registered | | | | No |
| 3 | 133VN1004X | Dietitian, Registered | Nutrition, Pediatric | | | No |
| 4 | 133N00000X | Nutritionist | | | | No |
| 5 | 133NN1002X | Nutritionist | Nutrition, Education | | | No |
| 6 | 163W00000X | Registered Nurse | | | | No |
| 7 | 163WN1003X | Registered Nurse | Nutrition Support | | | No |
| 8 | 163WP0200X | Registered Nurse | Pediatrics | | | No |
| 9 | 164W00000X | Licensed Practical Nurse | | | | No |
| 10 | 225X00000X | Occupational Therapist | | | | No |
| 11 | 225100000X | Physical Therapist | | | | No |
| 12 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 13 | 252Y00000X | Early Intervention Provider Agency | | | | Yes |