=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235606401
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN E OTTE PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2018
-----------------------------------------------------
Last Update Date | 10/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 HAMILTON AVE STE 240
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94301-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-517-1606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 HAMILTON AVE STE 240
-----------------------------------------------------
City | PALO ALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94301-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-517-1606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY23045
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------