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NPI Code Detail

MEDICARE: MISS JOELLE RENEE OTTERSTEDT

MEDICARE: MISS JOELLE RENEE OTTERSTEDT
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
1106S00000XBehavior TechnicianOR

General Provider Information

NPI Number : 1326507898
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JOELLE RENEE OTTERSTEDT
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 400 E MAIN ST STE 180
Second Line :
City : HILLSBORO
State : OR
Zip : 97123-4161
Country : US
Telephone Number : 971-762-1144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2019
Last Update Date : 03/14/2019

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Directions to “ MISS JOELLE RENEE OTTERSTEDT ” Practice Location

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