Provider Demographics
NPI:1023606449
Name:MARRIOTT, MOLLY MAY (RDN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MAY
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:MAY
Other - Last Name:SATTERTHWAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1605 S ELLIS ST APT 250
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-3219
Mailing Address - Country:US
Mailing Address - Phone:801-920-0887
Mailing Address - Fax:
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86148056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered