Healthcare Provider Details

I. General information

NPI: 1164206488
Provider Name (Legal Business Name): LINDA ANN SEWELL-OTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10806 HATCHER ST
MILTON FL
32583-8199
US

IV. Provider business mailing address

10806 HATCHER ST
MILTON FL
32583-8199
US

V. Phone/Fax

Practice location:
  • Phone: 951-834-4601
  • Fax:
Mailing address:
  • Phone: 951-834-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: