Provider Demographics
NPI:1124454673
Name:HOCHWALT, ALLYSON (RD/LD)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:HOCHWALT
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 PERSHING DR E
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3443
Mailing Address - Country:US
Mailing Address - Phone:937-304-8735
Mailing Address - Fax:
Practice Address - Street 1:815 PERSHING DR E
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3443
Practice Address - Country:US
Practice Address - Phone:937-304-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1372133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered