Healthcare Provider Details

I. General information

NPI: 1275750267
Provider Name (Legal Business Name): JANE FRANCES OTSTOT L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 N 47TH AVE
PHOENIX AZ
85019-3206
US

IV. Provider business mailing address

4510 N 37TH AVE
PHOENIX AZ
85019-3206
US

V. Phone/Fax

Practice location:
  • Phone: 602-336-2990
  • Fax:
Mailing address:
  • Phone: 602-336-2990
  • Fax: 602-336-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC10364
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: