Healthcare Provider Details

I. General information

NPI: 1679194492
Provider Name (Legal Business Name): OTTO ROTHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 UPTON RD
COLCHESTER CT
06415-2756
US

IV. Provider business mailing address

87 BURNBROOK RD
EAST HARTFORD CT
06118-2009
US

V. Phone/Fax

Practice location:
  • Phone: 860-822-4719
  • Fax:
Mailing address:
  • Phone: 860-895-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9557
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: