Healthcare Provider Details

I. General information

NPI: 1225480411
Provider Name (Legal Business Name): OTTO SHILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12810 E NORA AVE STE F
SPOKANE VALLEY WA
99216-1055
US

IV. Provider business mailing address

12810 E NORA AVE STE F
SPOKANE VALLEY WA
99216-1055
US

V. Phone/Fax

Practice location:
  • Phone: 509-303-4001
  • Fax: 509-286-1354
Mailing address:
  • Phone: 509-303-4001
  • Fax: 509-286-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP60842403
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberOP60842403
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: