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General NPI Number Information
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NPI Number | 1235605171
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Entity Type | Organization
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Legal Business Name | INSPIRE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 1288 VALLEY FORGE RD UNIT 54
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City | PHOENIXVILLE
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State | PA
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Zip | 19460
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Country | US
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Telephone | 267-563-8180
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Fax | 484-848-5195
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Provider Business Mailing Address
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Address Line | 36 FAIRWAY DRIVE
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City | SOUTHERN SHORES
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State | NC
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Zip | 27949
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Country | US
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Telephone | 215-817-5055
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Fax | 484-848-5195
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTINE S. OTT
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Credential | CRNP
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Telephone | 267-563-8180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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