Doctor Name: | CHRISTINA OTTO |
NPI Number: | 1285820779 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MACCC, SLP |
License Number: | SLP1460 |
Business Practice Address: | 890 N Cole Rd Suite A Boise, ID - 837048638 |
Business Phone Number: | 2083238888 |
Business Fax Number: | 2083238889 |
Mailing Address: | 7334 Gillis Rd, BOISE |
State: | ID |
Postal Code: | 837145016 |
Phone Number: | 2088531772 |
Fax Number: | |
NPI Enumeration Date: | 09/19/2007 |
NPI Last Update Date: | 09/19/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP1460 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |