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General NPI Number Information
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NPI Number | 1104067057
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Entity Type | Individual
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Provider Name | DIANE M OTT L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 3117 WASHINGTON PIKE SUITE 200
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-1434
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Country | US
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Telephone | 412-221-1091
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Fax | 412-221-2939
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Provider Business Mailing Address
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Address Line | 3117 WASHINGTON PIKE SUITE 200
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-1434
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Country | US
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Telephone | 412-221-1091
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Fax | 412-221-2939
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC004281
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License Number State | PA
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