Healthcare Provider Details

I. General information

NPI: 1396793634
Provider Name (Legal Business Name): EMORY L OTTO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E OREGON RD
LITITZ PA
17543-9205
US

IV. Provider business mailing address

1001 E OREGON RD
LITITZ PA
17543-9205
US

V. Phone/Fax

Practice location:
  • Phone: 717-581-3976
  • Fax: 717-509-5410
Mailing address:
  • Phone: 717-581-3976
  • Fax: 717-509-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPS005174L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005174L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: