=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306980305
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY RANAE OTT MS, ATC, CSCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 S PARK ST MERITER ATRIUM
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53715-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-267-5883
-----------------------------------------------------
Fax | 608-267-5966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 831 FOREST VIEW DR
-----------------------------------------------------
City | VERONA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53593-1738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-497-0491
-----------------------------------------------------
Fax | 608-267-5966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 413-039
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------