MEDICARE: SARAH OTIS

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
1	103TC0700X	Clinical Psychologist	3623	TN

General Provider Information

NPI Number	:	1699614222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH OTIS

Provider Business Mailing Address
First Line	:	6011 CHESTERTON WAY STE 209
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-1523
Country	:	US
Telephone Number	:	423-414-4997
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 CHESTERTON WAY STE 209
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-1523
Country	:	US
Telephone Number	:	423-414-4997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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Directions to “ SARAH OTIS ” Practice Location

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