MEDICARE: KRISTEN ANNE OTTO OTR/L

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	225X00000X	Occupational Therapist	2541	AZ
2	225X00000X	Occupational Therapist	15045	CA

General Provider Information

NPI Number	:	1841242518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN ANNE OTTO OTR/L

Provider Business Mailing Address
First Line	:	1342 E DUNBAR DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5668
Country	:	US
Telephone Number	:	602-614-2243
Fax Number	:

Provider Business Practice Location Address
First Line	:	10120 N BAIRD AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-5101
Country	:	US
Telephone Number	:	602-614-2243
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/08/2022

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