Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810006448 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810006448 | VA |
NPI | 1003439613 |
---|---|
Provider Name | Hannah Jean Ottmar |
First Address | Salem, VA 24153-6404 |
Second Address | Grand Junction, CO 81501-6428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2020 |
Last Update Date | 19/05/2020 |