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General NPI Number Information
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NPI Number | 1578426755
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Entity Type | Individual
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Provider Name | GERI LYNN OTASEVIC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2933 MCCARTHY ST
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City | SCRANTON
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State | PA
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Zip | 18505-3017
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Country | US
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Telephone | 570-446-8795
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Fax |
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Provider Business Mailing Address
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Address Line | 518 3RD ST
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City | DUNMORE
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State | PA
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Zip | 18512-3004
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Country | US
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Telephone | 570-446-8795
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN002416
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License Number State | PA
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