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NPI Code Detail

MEDICARE: TARA OTTENSTEIN

MEDICARE: TARA OTTENSTEIN
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
1106S00000XBehavior Technician
2175T00000XPeer Specialist
31041C0700XClinical Social Worker91335653502UT

General Provider Information

NPI Number : 1740701838
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA OTTENSTEIN
Provider Business Mailing Address
First Line : 3897 W 5425 S
Second Line :
City : ROY
State : UT
Zip : 84067-8140
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4645 MIDLAND DR STE 2
Second Line :
City : WEST HAVEN
State : UT
Zip : 84401-6825
Country : US
Telephone Number : 801-332-9139
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2017
Last Update Date : 10/28/2024

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Directions to “ TARA OTTENSTEIN ” Practice Location

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