Provider Demographics
NPI:1679544589
Name:BIXLER, ALYSSA (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BIXLER
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 N TRINE ST
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-1132
Mailing Address - Country:US
Mailing Address - Phone:614-566-3717
Mailing Address - Fax:614-566-3835
Practice Address - Street 1:3773 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3425
Practice Address - Country:US
Practice Address - Phone:614-566-3717
Practice Address - Fax:614-566-3835
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5678133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBIMT72871Medicare PIN