Healthcare Provider Details

I. General information

NPI: 1558974451
Provider Name (Legal Business Name): HEATHER NICOLE OTT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER NICOLE WILLIAMS

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PRO DR STE D4
CELINA OH
45822-3307
US

IV. Provider business mailing address

200 SAINT CLAIR AVE
SAINT MARYS OH
45885-2400
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-6480
  • Fax: 419-586-4125
Mailing address:
  • Phone: 419-300-1129
  • Fax: 419-586-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027447
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: