Provider Demographics
NPI:1902651375
Name:OPTIMAL OUTLOOK NUTRITION LLC
Entity Type:Organization
Organization Name:OPTIMAL OUTLOOK NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:304-667-1630
Mailing Address - Street 1:636 PUMPKIN RUN
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:WV
Mailing Address - Zip Code:24925-7142
Mailing Address - Country:US
Mailing Address - Phone:304-667-1630
Mailing Address - Fax:
Practice Address - Street 1:636 PUMPKIN RUN
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:WV
Practice Address - Zip Code:24925-7142
Practice Address - Country:US
Practice Address - Phone:304-667-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty