Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT003131L | PA |
NPI | 1104982248 |
---|---|
Provider Name | Mrs. Deborah K Ott |
First Address | Pipersville, PA 18947-1004 |
Second Address | Pipersville, PA 18947-1004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019326520003 | MEDICAL ASSISTANCE (01) | PA |