MEDICARE: HOWARD M. OTTENHEIMER PH.D.

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	103TC0700X	Clinical Psychologist	672	NM

General Provider Information

NPI Number	:	1427143965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD M. OTTENHEIMER PH.D.

Provider Business Mailing Address
First Line	:	6528 BARRANCA DR
Second Line	:
City	:	COCHITI LAKE
State	:	NM
Zip	:	87083-6009
Country	:	US
Telephone Number	:	505-989-3639
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 SAINT MICHAELS DR
Second Line	:	SUITE, 8
City	:	SANTA FE
State	:	NM
Zip	:	87505-7655
Country	:	US
Telephone Number	:	505-989-3639
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/25/2008

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