1730373150 NPI number — MS. FRANCES M OTTO MS, CCC-SLP,MOT

Table of content: MS. FRANCES M OTTO MS, CCC-SLP,MOT (NPI 1730373150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730373150 NPI number — MS. FRANCES M OTTO MS, CCC-SLP,MOT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTTO
Provider First Name:
FRANCES
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CCC-SLP,MOT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730373150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 RANCH ROAD 3237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WIMBERLEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78676-5311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-847-5540
Provider Business Mailing Address Fax Number:
512-847-0419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 RANCH ROAD 3237
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WIMBERLEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78676-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-847-5540
Provider Business Practice Location Address Fax Number:
512-847-0419
Provider Enumeration Date:
08/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT#104729 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: SP#2399 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 106544 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 164266721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".