=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770835365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSALIND OTI, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2012
-----------------------------------------------------
Last Update Date | 01/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1307 N 45TH ST SUITE 200
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-6741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-646-9479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1307 N 45TH ST SUITE 200
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-6741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ROSALIND OTI
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 734-646-9479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | PY60129895
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------