Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1162 | OR |
NPI | 1013040526 |
---|---|
Provider Name | Dr. Jeri Lynn Otterstrom |
First Address | Eugene, OR 97404-3230 |
Second Address | Eugene, OR 97404-3230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 14/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
229346 | (05) | OR |
43-1986773 | TAX ID (01) | OR |