Doctor Name: | ROBERT OTTO |
NPI Number: | 1033585609 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | 2015025674 |
Business Practice Address: | 962 S Clearwater Creek Dr Olathe, KS - 660615260 |
Business Phone Number: | 3168718881 |
Business Fax Number: | |
Mailing Address: | 962 S Clearwater Creek Dr, OLATHE |
State: | KS |
Postal Code: | 660615260 |
Phone Number: | 3168718881 |
Fax Number: | |
NPI Enumeration Date: | 08/18/2015 |
NPI Last Update Date: | 08/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2015025674 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |