Provider Demographics
NPI:1316488703
Name:KATIE DEFOE-RAYMOND
Entity type:Organization
Organization Name:KATIE DEFOE-RAYMOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFCIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFOE-RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:413-575-3048
Mailing Address - Street 1:2 MEDICAL CENTER DR
Mailing Address - Street 2:STE 404
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1270
Mailing Address - Country:US
Mailing Address - Phone:413-736-3163
Mailing Address - Fax:413-733-0206
Practice Address - Street 1:2 MEDICAL CENTER DR
Practice Address - Street 2:STE 404
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-736-3163
Practice Address - Fax:413-733-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty