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NPI Code Detail

MEDICARE: DR. ALLYSON OTTEN DPM

MEDICARE: DR. ALLYSON OTTEN DPM
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
1213E00000XPodiatrist1372-25WI
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1699478305
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALLYSON OTTEN DPM
Provider Business Mailing Address
First Line : W8340 S COUNTY ROAD A
Second Line :
City : ADELL
State : WI
Zip : 53001-1490
Country : US
Telephone Number : 262-483-9424
Fax Number :
Provider Business Practice Location Address
First Line : 5666 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2425
Country : US
Telephone Number : 815-395-5190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2023
Last Update Date : 03/02/2026

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