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General NPI Number Information
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NPI Number | 1295030997
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Entity Type | Individual
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Provider Name | KATHLEEN HEATHER OTTOLINI D.C.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 14377 WOODLAKE DR SUITE 315
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5735
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Country | US
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Telephone | 314-707-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 1813 WESTMEADE DR
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City | CHESTERFIELD
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State | MO
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Zip | 63017-4676
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Country | US
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Telephone | 314-707-0086
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Fax |
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2010031371
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License Number State | MO
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