| Doctor Name: | JODI OTIS |
| NPI Number: | 1700811130 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MPT, ATC |
| License Number: | 118132 |
| Business Practice Address: | 10435 Clayton Rd Suite 120 Frontenac, MO - 631312909 |
| Business Phone Number: | 3149853002 |
| Business Fax Number: | 3149853012 |
| Mailing Address: | 777 S New Ballas Rd, Ste. 116e SAINT LOUIS |
| State: | MO |
| Postal Code: | 631418705 |
| Phone Number: | 3149853002 |
| Fax Number: | 3149853012 |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 118132 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |