| Doctor Name: | MS. SHANNON JOEL OTTO |
| NPI Number: | 1114049673 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 313365 |
| Business Practice Address: | 220 4th Ave Raton, NM - 877402643 |
| Business Phone Number: | 5754452754 |
| Business Fax Number: | 5754452225 |
| Mailing Address: | 330 S 7th St, RATON |
| State: | NM |
| Postal Code: | 877404049 |
| Phone Number: | 5753901958 |
| Fax Number: | |
| NPI Enumeration Date: | 04/04/2007 |
| NPI Last Update Date: | 11/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | 313365 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |