Healthcare Provider Details

I. General information

NPI: 1073852182
Provider Name (Legal Business Name): LAUREN MARIE OTT ED.S., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MCCOY RD
HUNTINGTON WV
25701-4937
US

IV. Provider business mailing address

2001 MCCOY RD
HUNTINGTON WV
25701-4937
US

V. Phone/Fax

Practice location:
  • Phone: 304-529-6205
  • Fax:
Mailing address:
  • Phone: 304-529-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: