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NPI Code Detail

MEDICARE: JOCELYN OTANI

MEDICARE: JOCELYN OTANI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YP2500XProfessional CounselorC6682OR

General Provider Information

NPI Number : 1154818045
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOCELYN OTANI
Provider Business Mailing Address
First Line : 2577 NE COURTNEY DR
Second Line :
City : BEND
State : OR
Zip : 97701-7752
Country : US
Telephone Number : 541-322-7500
Fax Number : 541-322-7565
Provider Business Practice Location Address
First Line : 406 W ANTLER AVE
Second Line :
City : REDMOND
State : OR
Zip : 97756-1812
Country : US
Telephone Number : 541-322-7500
Fax Number : 541-322-7565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2018
Last Update Date : 03/28/2022

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Directions to “ JOCELYN OTANI ” Practice Location

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