MEDICARE: TARAH OTT

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1235524992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARAH OTT

Provider Business Mailing Address
First Line	:	2395 LINCOLN MEADOWS DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89521-5252
Country	:	US
Telephone Number	:	775-376-9426
Fax Number	:	775-376-5888

Provider Business Practice Location Address
First Line	:	5345 RENO CORPORATE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2381
Country	:	US
Telephone Number	:	775-376-9426
Fax Number	:	775-376-5888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	04/29/2024

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Directions to “ TARAH OTT ” Practice Location

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