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General NPI Number Information
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NPI Number | 1275523276
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Entity Type | Individual
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Provider Name | TODD M OTSTOT PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 206 E ELM ST
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City | CALDWELL
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State | ID
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Zip | 83605-4815
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Country | US
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Telephone | 208-459-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 206 E ELM ST
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City | CALDWELL
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State | ID
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Zip | 83605-4815
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Country | US
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Telephone | 208-459-4511
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Fax | 208-459-6602
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-356
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA356
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-356
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License Number State | ID
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