Provider Demographics
NPI:1861527525
Name:FOX, TERRI L (RDN, CDE)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-2105
Mailing Address - Country:US
Mailing Address - Phone:360-791-3781
Mailing Address - Fax:
Practice Address - Street 1:703 LILLY RD NE
Practice Address - Street 2:SUITE E
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5191
Practice Address - Country:US
Practice Address - Phone:360-791-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000496,133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8276529Medicaid
WAGAB28739Medicare PIN
WAG8872329Medicare PIN
WAP57877Medicare UPIN
WAGAB28737Medicare PIN
WAGAB28736Medicare PIN