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General NPI Number Information
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NPI Number | 1376933168
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Entity Type | Organization
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Legal Business Name | MARIA L. OTT, PSY. D., P.C.
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Dates
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Enumeration Date | 01/31/2015
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 2860 S CIRCLE DR 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-4113
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Country | US
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Telephone | 719-465-4340
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Fax |
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Provider Business Mailing Address
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Address Line | 6455 BLUFFMONT PT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-8401
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Country | US
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Telephone | 719-465-4340
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | MARIA LISA OTT
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Credential | PSY.D.
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Telephone | 719-465-4340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3064
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License Number State | CO
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