Provider Demographics
NPI:1396141594
Name:GILES, KATHERINE (MS, RD, LDN)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 GREAT RD STE 6
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5683
Mailing Address - Country:US
Mailing Address - Phone:508-372-0513
Mailing Address - Fax:
Practice Address - Street 1:145 GREAT RD STE 6
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5683
Practice Address - Country:US
Practice Address - Phone:508-372-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-15
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000003660133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA220063Medicare Oscar/Certification