Healthcare Provider Details

I. General information

NPI: 1851130355
Provider Name (Legal Business Name): MARY OTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 N LAKE SHORE DR APT 6B
CHICAGO IL
60657-3914
US

IV. Provider business mailing address

3260 N LAKE SHORE DR APT 6B
CHICAGO IL
60657-3914
US

V. Phone/Fax

Practice location:
  • Phone: 773-816-0114
  • Fax:
Mailing address:
  • Phone: 773-816-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: