Provider Demographics
NPI:1053622746
Name:TAIT, KAREN SUE I (DT (DIETETIC TECH))
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:TAIT
Suffix:I
Gender:F
Credentials:DT (DIETETIC TECH)
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:SCHNEIDERHAN
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 W RIVER FRONT DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4459
Mailing Address - Country:US
Mailing Address - Phone:414-962-8881
Mailing Address - Fax:414-962-8881
Practice Address - Street 1:434 W RIVER FRONT DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4459
Practice Address - Country:US
Practice Address - Phone:414-881-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist