Healthcare Provider Details

I. General information

NPI: 1568083152
Provider Name (Legal Business Name): JUSTIN ANDREW OTT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 KNOWLES AVE STE 114
SOUTHAMPTON PA
18966-1530
US

IV. Provider business mailing address

2836 RAWLE ST
PHILADELPHIA PA
19149-2521
US

V. Phone/Fax

Practice location:
  • Phone: 215-942-7990
  • Fax:
Mailing address:
  • Phone: 215-380-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: