Healthcare Provider Details

I. General information

NPI: 1285333567
Provider Name (Legal Business Name): SAVANNAH ALEXIS OTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 ALDER ST
BROOKINGS OR
97415-9014
US

IV. Provider business mailing address

PO BOX 6481
BROOKINGS OR
97415-0281
US

V. Phone/Fax

Practice location:
  • Phone: 541-813-1863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27226
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: