Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C52965 | CA |
NPI | 1467947879 |
---|---|
Provider Name | Mr. Dylan Otten |
First Address | Chico, CA 95926-1991 |
Second Address | Chico, CA 95926-1991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2018 |
Last Update Date | 27/06/2018 |