Active NPI
Tara L. Spisak, RD, LD, CDE
- Registered Dietitian
- Archbold, OH
National Provider Identifier
1134433618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD.4906
- Practice address
- 121 Westfield Dr Ste 1
Archbold, OH 43502-1005 - Phone
- (419) 445-2015
- Fax
- (419) 445-8102
- NPI assigned
- Jul 27, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD.4906 | OH | Primary |
Addresses
Primary practice location
121 Westfield Dr Ste 1
Archbold, OH 43502-1005
Mailing address
11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L4906 | OH | MD | Registered Dietitian |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Bryan, OH
- NPI 1619915170
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782691200000",
"number": "1134433618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11109 PARKVIEW PLAZA DR # 117",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468451701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 WESTFIELD DR STE 1",
"city": "ARCHBOLD",
"state": "OH",
"postal_code": "435021005",
"telephone_number": "419-445-2015",
"fax_number": "419-445-8102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPISAK",
"first_name": "TARA",
"middle_name": "L.",
"credential": "RD, LD, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-27",
"last_updated": "2026-06-29",
"certification_date": "2026-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "LD.4906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Archbold, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.