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General NPI Number Information
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NPI Number | 1376645747
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Entity Type | Individual
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Provider Name | KIMBERLY KAYE OTTWELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | U.S. DEPARTMENT OF STATE M/MED/QI, SA-1
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City | WASHINGTON
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State | DC
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Zip | 20522-0102
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Country | US
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Telephone | 202-663-2453
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Fax | 202-663-3247
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Provider Business Mailing Address
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Address Line | U.S. DEPARTMENT OF STATE M/MED/QI, SA-1 KIMBERLY OTTWELL, MD
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City | WASHINGTON
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State | DC
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Zip | 20522-0102
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Country | US
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Telephone | 202-663-2453
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Fax | 202-663-3247
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20319
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License Number State | AZ
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