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NPI Code Detail

MEDICARE: CHRISTINA RENEE OTTO LLMSW, DP-C

MEDICARE: CHRISTINA RENEE OTTO LLMSW, DP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801103405MI

General Provider Information

NPI Number : 1386116812
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA RENEE OTTO LLMSW, DP-C
Provider Business Mailing Address
First Line : 828 W BLUE GRASS RD
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-9566
Country : US
Telephone Number : 989-400-0773
Fax Number :
Provider Business Practice Location Address
First Line : 2800 S SHEPHERD RD
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-8966
Country : US
Telephone Number : 989-775-4850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2018
Last Update Date : 12/21/2018

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